Brynna Crovetto, PharmD
Pharmacy Resident
R Adams Cowley Shock Trauma Center
Disclosure information not submitted.
Luigi Brunetti, PharmD, MPH, BCPS, BCGP
Clinical Pharmacy Specialist
Robert Wood Johnson University Hospital Somerset, United States
Disclosure information not submitted.
Title: Comparison of vancomycin AUC versus trough dosing strategies on nephrotoxicity: a meta-analysis
Introduction: Vancomycin, a glycopeptide antibiotic, has been widely linked to reports of nephrotoxicity following its administration. Vancomycin is commonly administered as a broad-spectrum antibiotic for patients in septic shock in intensive care units and these patients are at an increased risk of acute kidney injury (AKI). New guidelines have supported the use of dosing vancomycin based on AUC rather than trough. The aim of this meta-analysis is to compare the incidence of nephrotoxicity with AUC-guided dosing strategies versus conventional trough monitoring.
Methods: All literature was queried from PubMed and Google Scholar through March 5th, 2021. Studies included were observational in nature and reported the outcomes of interest: incidence of nephrotoxicity with vancomycin therapy utilizing traditional trough-based dosing strategies versus incidence utilizing AUC-guided dosing strategies. Data was extracted from the selected studies and the outcome of AKI incidence was evaluated among the two dosing strategies using meta-analysis with both a fixed effect and random effect approach. Heterogeneity was identified using the Cochrane I2 statistic; I2 values ≥ 75% indicated significant heterogeneity. Publication bias was assessed by visual inspection of a funnel plot of the studies. All analyses were performed using Comprehensive Meta-Analysis version 3.0 (Englewood, NJ).
Results: A total of 4 studies meeting all inclusion and exclusion criteria were included in this meta-analysis. A total of 1902 patients were included across the four studies in the analysis and were stratified and compared by type of AUC calculation and trough definition. A statistically significant difference was found when all articles were compiled into one analysis regarding AKI incidence rate when comparing AUC versus trough [OR 0.656, 95% CI [0.469-0.918]; p = 0.014, I2 = 48%]. Incidence of utilization of AKI was found to be significantly less with utilization of Bayesian dosing software [OR 0.182, 95% CI [0.059-0.563], p = 0.003; I2 = 0%].
Conclusions: Utilization of AUC-guided dosing strategies versus traditional trough guided dosing strategies may contribute to a lower incidence of nephrotoxicity in patients treated with vancomycin. Further studies are required to elicit this effect and confirm the findings of our analysis.