In Outpatients Receiving Parenteral Vancomycin, Dosing Adjustments Produced by Area Under the Curve-Based and Trough-Based Monitoring Differ Only at the Extremes of the Therapeutic Trough Range

Abstract Area under the curve (AUC)-based vancomycin dosing reduces nephrotoxicity but is burdensome. Reviewing 115 adults receiving ≥2 weeks of outpatient vancomycin, we found AUC-based and trough-based dose adjustments discordant only for troughs 16 mg/L. Selective versus universal outpatient AUC calculation would likely offer similar benefit with reduced workload. Outpatient AUC- and trough-based vancomycin monitoring produced similar dose adjustment recommendations for serum troughs 12–16 mg/L but diverged at the 10–20 mg/L range. Selective versus universal AUC monitoring may similarly reduce vancomycin nephrotoxicity with substantially lower workload.