African Journal of
Pharmacy and Pharmacology

  • Abbreviation: Afr. J. Pharm. Pharmacol.
  • Language: English
  • ISSN: 1996-0816
  • DOI: 10.5897/AJPP
  • Start Year: 2007
  • Published Articles: 2283

Full Length Research Paper

Relationship between vancomycin trough concentration and 24-h area under the curve concentration in Tunisian patients

Sarra MAHFOUDHI
  • Sarra MAHFOUDHI
  • Department of Analytical Chemistry (LR12ES09), University of Pharmacy, Road Avicenne 5000, Monastir, Tunisia.
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Emna GAIES
  • Emna GAIES
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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CHARFI Rim
  • CHARFI Rim
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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Nadia JEBABLI
  • Nadia JEBABLI
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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Mouna BEN SASSI
  • Mouna BEN SASSI
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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Hanene EL JEBARI
  • Hanene EL JEBARI
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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Daghfous Riadh
  • Daghfous Riadh
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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Sameh TRABELSI
  • Sameh TRABELSI
  • Department of Clinical Pharmacology-National Centre “Chalbi Belkahia” of Pharmacovigilance, Tunis, Tunisia.
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  •  Received: 09 November 2022
  •  Accepted: 05 June 2023
  •  Published: 30 June 2023

Abstract

The 24-h area under the curve concentration (AUC24 h) is associated with better clinical and bacteriological response to vancomycin in patients with methicillin-resistant Staphylococcus aureus who achieve the target AUC24 h between 400 and 700 mg×h/L. Recent consensus recommends maintaining trough concentrations between 15 and 20 mg/mL as a convenient target  to reach an AUC/minimum inhibitory concentration (MIC) ≥ 400. The aim of this study was to determine the correlation between a calculated AUC24 h and a measured trough vancomycin concentration (C0). We conducted a retrospective observational study. Hospitalized patients prescribed vancomycin for a presumed or documented invasive staphylococcal infections were evaluated. A formula based on the relationship between dose, vancomycin clearance and creatinine clearance was used to determine each patient's AUC24 h. 161 patients were included in the study. Median age was 34 years. The mean daily dose of vancomycin was 28 mg/kg/day. The median vancomycin C0 was 12.2 mg/mL, 17.3% were in the therapeutic range. The median AUC was 246.84 mg×h/L, only 8% achieved the target AUC24 h between 400 and 700 mg×h/L. Of these, 3 patients had C0 between 15 and 20 mg/mL and 9 patients had C0> 20 mg/mL. A poor correlation was found between C0 and AUC24 h = 0.37; r2 = 0.14; p<0.0001. In conclusion, vancomycin C0 correlated poorly with AUC24/MIC targets. C0 seems to underestimate AUC24 h. So, a patient specific AUC24/MIC may serve to predict efficacy while C0 can be used as indicators of possible nephrotoxicity and development of resistance.

Key words: Vancomycin, area under the curve (AUC), trough concentration, minimum inhibitory concentration, therapeutic drug monitoring.