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Review
. 2022 Feb 23;14(3):489.
doi: 10.3390/pharmaceutics14030489.

Clinical Practice Guidelines for Therapeutic Drug Monitoring of Vancomycin in the Framework of Model-Informed Precision Dosing: A Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

Kazuaki Matsumoto  1 , Kazutaka Oda  2 , Kensuke Shoji  3 , Yuki Hanai  4 , Yoshiko Takahashi  5 , Satoshi Fujii  6 , Yukihiro Hamada  7 , Toshimi Kimura  7 , Toshihiko Mayumi  8 , Takashi Ueda  9 , Kazuhiko Nakajima  9 , Yoshio Takesue  9   10
Affiliations
Review

Clinical Practice Guidelines for Therapeutic Drug Monitoring of Vancomycin in the Framework of Model-Informed Precision Dosing: A Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

Kazuaki Matsumoto et al. Pharmaceutics. .

Abstract

Background: To promote model-informed precision dosing (MIPD) for vancomycin (VCM), we developed statements for therapeutic drug monitoring (TDM).

Methods: Ten clinical questions were selected. The committee conducted a systematic review and meta-analysis as well as clinical studies to establish recommendations for area under the concentration-time curve (AUC)-guided dosing.

Results: AUC-guided dosing tended to more strongly decrease the risk of acute kidney injury (AKI) than trough-guided dosing, and a lower risk of treatment failure was demonstrated for higher AUC/minimum inhibitory concentration (MIC) ratios (cut-off of 400). Higher AUCs (cut-off of 600 μg·h/mL) significantly increased the risk of AKI. Although Bayesian estimation with two-point measurement was recommended, the trough concentration alone may be used in patients with mild infections in whom VCM was administered with q12h. To increase the concentration on days 1-2, the routine use of a loading dose is required. TDM on day 2 before steady state is reached should be considered to optimize the dose in patients with serious infections and a high risk of AKI.

Conclusions: These VCM TDM guidelines provide recommendations based on MIPD to increase treatment response while preventing adverse effects.

Keywords: area under the concentration-time curve; guideline; model-informed precision dosing; therapeutic drug monitoring; vancomycin.

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Conflict of interest statement

K. Matsumoto received grant support from Meiji Seika Pharma Co., Ltd. Y. Takesue received grant support from Shionogi & Co., Ltd. and payment for lectures from Astellas Pharma Inc. and MSD Japan. Y. Hamada received speaker honoraria from Pfizer Japan Inc. T. Kimura received payment for lectures from Meiji Seika Pharma Co., Ltd. T. Mayumi received grant support from Roche Diagnostics K.K. The other authors have no conflict of interest to declare.

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