A Canadian perspective on the revised 2020 ASHP-IDSA-PIDS-SIDP guidelines for vancomycin AUC-based therapeutic drug monitoring for serious MRSA infections.

Autor:	Stewart JJ; Pharmacy Department, Alberta Health Services, Edmonton, Alberta, Canada., Jorgensen SC; Pharmacy Department, Mount Sinai Hospital, Toronto, Ontario, Canada., Dresser L; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.; Department of Pharmacy, Sinai Health System, Toronto, Ontario, Canada., Lau TT; Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada.; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.; Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Gin A; Winnipeg Regional Health Authority Regional Pharmacy Program, Winnipeg, Manitoba, Canada.; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Thirion DJ; Pharmacy Department, McGill University Health Centre, Montreal, Quebec, Canada.; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada., Nishi C; Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada.; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.; Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Dalton B; Pharmacy Department, Alberta Health Services, Edmonton, Alberta, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada [J Assoc Med Microbiol Infect Dis Can] 2021 May 03; Vol. 6 (1), pp. 3-9. Date of Electronic Publication: 2021 May 03 (Print Publication: 2021).
DOI:	10.3138/jammi-2020-0028
Abstrakt:	Background: A revised consensus guideline on therapeutic drug monitoring (TDM) of vancomycin for serious methicillin-resistant Staphylococcus aureus (MRSA) infections was recently published with endorsement of numerous American pharmacy and medical societies. Changing practice from trough TDM to area-under-the-curve-(AUC)-guided dosing was suggested. Methods: Recent literature was critically appraised to determine whether AUC TDM is appropriate for Canadian hospital practice. Results: Previous 2009 vancomycin consensus guidelines recommended trough levels of 15-20 mg/L for serious MRSA infections, based on relatively poor evidence for efficacy or safety. In the past decade, aggressive trough targets have led to unnecessary toxicity. Adoption of a TDM strategy using an alternative parameter (AUC) has been suggested, although the evidence for any outcome benefits is low quality. In addition, implementation would require greater resources at health care institutions in the forms of more frequent serum levels or acquisition of costly Bayesian software programs. Most studies on this subject have been observational and retrospective; therefore, relationships between TDM parameters and outcomes have not been convincingly and consistently demonstrated to be causal in nature. Despite claims to the contrary, based on few in silico experiments, available clinical data suggest correlation of trough levels and AUC is high. TDM with lower target trough levels is a simpler solution to reduce risk of toxicity. Conclusions: There are serious concerns with adoption of AUC TDM of vancomycin into routine practice in Canada. Trough-based monitoring with modest reduction in target levels remains the most evidence-informed practice at this time. Competing Interests: Dr Thirion reports personal fees from Sunovion outside the submitted work. (Copyright © 2021, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)
Databáze:	MEDLINE
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