Identification of Patients Who Require Two-Point Blood Sampling for the Peak and Trough Values Rather Than One-Point Blood Sampling for the Trough Value for the Evaluation of AUC of Vancomycin Using Bayesian Estimation

Objectives It is recommended to adjust the dose of vancomycin (VCM) with a target area under the concentration–time curve (AUC) of 400–600 μg·h/mL. Factors that affect the deviation between AUCs are estimated from the trough value alone and the trough and peak values using practical AUC-guided thera...

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Veröffentlicht in:Pharmaceutical research 2024-11, Vol.41 (11), p.2161-2171
Hauptverfasser: Suzuki, Ayako, Samura, Masaru, Ishigo, Tomoyuki, Fujii, Satoshi, Ibe, Yuta, Yoshida, Hiroaki, Tanaka, Hiroaki, Ebihara, Fumiya, Maruyama, Takumi, Hamada, Yukihiro, Fujihara, Hisato, Yamaguchi, Fumihiro, Nagumo, Fumio, Komatsu, Toshiaki, Tomizawa, Atsushi, Takuma, Akitoshi, Chiba, Hiroaki, Nishi, Yoshifumi, Enoki, Yuki, Taguchi, Kazuaki, Matsumoto, Kazuaki
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Sprache:eng
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Zusammenfassung:Objectives It is recommended to adjust the dose of vancomycin (VCM) with a target area under the concentration–time curve (AUC) of 400–600 μg·h/mL. Factors that affect the deviation between AUCs are estimated from the trough value alone and the trough and peak values using practical AUC-guided therapeutic drug monitoring (PAT) for vancomycin. In this study, factors that affect AUC were evaluated. Methods AUCs were estimated from a single trough value and trough and peak values, and the patients were classified into those who showed a 10% or greater deviation (deviation group) and those in whom the deviation was less than 10% (no-deviation group). Risk factors related to ≥ 10% deviation of AUC were identified by univariate and multivariate analysis. Results As a result of univariate and multivariate analysis of 30 patients in the deviation group and 344 patients in the no-deviation group, a creatinine clearance (CLcr) of ≥ 110 mL/min (odds ratio (OR) = 3.697, 95% confidence interval (CI) = 1.616–8.457, p = 0.002), heart failure with a brain natriuretic peptide (BNP) of ≥ 300 pg/mL (OR = 4.854, 95%CI = 1.199–19.656, p = 0.027), and the concomitant use of angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (ACE-I/ARB) (OR = 2.544, 95%CI = 1.074–6.024, p = 0.034) were identified as risk factors of ≥ 10% deviation of AUC. Conclusions Estimation of AUC by two-point blood sampling for the trough and peak values rather than one-point blood sampling for the trough value is suggested to improve the prediction accuracy in patients with enhanced renal function, severe heart failure, and patients using ACE-I/ARB.
ISSN:0724-8741
1573-904X
1573-904X
DOI:10.1007/s11095-024-03781-4