Pharm Sci. 2021;27(2): 201-208.
doi: 10.34172/PS.2020.70
  Abstract View: 222
  PDF Download: 92

Research Article

Evaluation of the Association between Trough and Area Under the Curve to Minimum Inhibitory Concentration Ratio (AUC24/MIC) of Vancomycin in Infected Patients with Methicillin Resistant Staphylococcus aureus (MRSA)

Ayda Esmaeili 1 ORCID logo, Mohammadreza Salehi 2, Nava Makhdoomi 3, Yalda H. Ardakani 4, Mehdi Rajabi 3,5, Soha Namazi 6* ORCID logo

1 Clinical Pharmacy Department, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran.
2 Department of Infectious Diseases and Tropical Medicines, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran.
3 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
4 Biopharmaceutics and Pharmacokinetic Division, Department of Pharmaceutics, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
5 Department of Clinical Pharmacy, University Hospitals of North Midlands NHS Trust, United Kingdom.
6 Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences,Tehran, Iran.


Background: The recent studies emphasized on the correlation of vancomycin antibacterial effect with pharmacokinetics properties such as the area under the curve/minimum inhibitory concentration (AUC24/MIC) ≥400 and serum trough level 15-20 mg /L in the patients with severe infection with methicillin-resistant Staphylococcus aureus (MRSA). The purpose is to assay the vancomycin pharmacokinetic properties in our population and evaluates the correlation between AUC24/MIC and trough serum level of vancomycin in given patients.

Methods: The patients with a positive MRSA culture, treated with vancomycin, were enrolled in this cross-sectional study. Three plasma samples were obtained during the study including 30 min before fourth and the fifth dose as trough levels and 1 hour after the fourth dose as peak level to determine AUC24. E-TEST determined the MIC of vancomycin.

Results: Thirty-eight patients with an average age of 48.33±16.44 were enrolled in this study. The mean ± SD of MIC was 0.99±0.30 mg/L. Thirty-four patients reached the adequate therapeutic range of AUC24/MIC ≥ 400 due to the standard vancomycin dosing method. In comparison, only 7 and 10 patients had the first and second trough levels in target intervals of 15-20 mg/L, respectively. Due to the receiver operating characteristic curve test (ROC test), the trough level after the fourth dose had a strong correlation with target AUC24/MIC with a sensitivity of 94.1%and specificity of 75.0%.

Conclusion: This study concluded using only a trough level is not appropriate for therapeutic drug monitoring (TDM) of vancomycin. In our population, target AUC24/MIC (≥ 400) had a reasonably strong correlation with the trough level before the fifth dose which achieved with trough level ≥10.81 mg/L and MIC< 1 mg/L.

Keywords: Vancomycin, Trough serum level, AUC/MIC, Severe infection, Methicillin-resistant Staphylococcus aureus, Therapeutic drug monitoring (TDM)
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Submitted: 13 Apr 2020
Revision: 13 Aug 2020
Accepted: 28 Aug 2020
ePublished: 02 Oct 2020
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