Co-author of the 2020 Vancomycin Guidelines, Tom Lodise, PharmD, PhD, Professor, Albany College of Pharmacy and Health Sciences talks about the transition to AUC-guided dosing one year later. As we approach the one-year anniversary of the 2020 vancomycin therapeutic monitoring guidelines , 1 we wanted to reflect on key therapeutic. The 2020 vancomycin dosing guidelines from four leading pharmacy and infectious diseases professional societies - ASHP, IDSA, PIDS, and SIDP - were published in advance online in the American Journal of Health-System Pharmacy based on actual body weight; maximum of 2g/dose for initial maintenance doses (prior to vancomycin levels) doses greater than 500 mg - round to the nearest 250 mg doses less than 500 mg - round to the nearest 50 m IV Vancomycin dosing and monitoring Antibiotic Guidelines Reference Number: 144TD(C)25(H3) Version Number: 6.1 Issue Date: 21/07/2020 Page 1 of 12 It is your responsibility to check on the intranet that this printed copy is the latest version IV Vancomycin dosing and monitoring Antibiotic Guidelines Last Updated: November 2020 AUC-BASED VANCOMYCIN MONITORING Guideline recommendations for AUC-based vancomycin dosing are for severe MRSA infections. The specific AUC targets for all vancomycin dosing will be used with the assumption that if a target that is validated for use in severe infections i
guideline focuses on optimization of vancomycin dosing and monitoring, recommendations on the appropriate-ness of vancomycin use, combination or alternative antibiotic therapy, and multiple medical interventions that may be necessary for successful treat-ment of invasive MRSA infections are beyond the scope of this guideline an ADULT INTRAVENOUS VANCOMYCIN DOSING AND MONITORING GUIDELINES DOSE: Adult dose: (based on actual body weight (ABW))*,^: 12.5 to 15 mg/kg (round off to nearest 250 mg increment, to max dose of 1500mg; see dosing table) * If ABW is > 30% ideal body weight (IBW), then use adjusted body weight = IBW + 0.4(Total body weight - IBW) IBW Males = 50 kg + 2.3 kg for each inch > 60 inches IBW Females.
The 2020 guidelines dance around the dosing issues around MRSA isolates with a vancomycin MICBMD = 2 mg/L. On one hand, they argue that automated susceptibility testing methods are imprecise, but they state that alternative therapy should be considered since AUC/MIC targets may not be safely achieved
In March 2020, the new guidelines for vancomycin dosing were released, with the major changes including the transition from a trough-based monitoring process to area under the curve (AUC)-based dosing strategies. 1. A survey conducted between March 30 and April 6 by InsightRx found that implementing the new vancomycin guidelines into the pharmacy community is as important as coronavirus. What Pharmacists Can Do to Prepare for the New Vancomycin Guidelines. March 19, 2020. Jill Murphy, Assistant Editor. With the publication of the new vancomycin guidelines, pharmacists are going to experience a major change from trough-based monitoring of vancomycin to area under the curve-based dosing strategies
This white paper reviews the 2020 vancomycin dosing guidelines that recommend AUC-guided dosing in general, and preferentially recommend Bayesian precision dosing software Amended: October 2020 . VANCOMYCIN DOSING AND MONITORING GUIDELINES (NB Provincial Health Authorities Anti-Infective Stewardship Committee ) GENERAL COMMENTS • Vancomycin is a glycopeptide antibiotic with bactericidal activity • It is active against gram -positive bacteria, including methicillin-resistant staphylococcus (MRSA Title: Microsoft Word - Vancomycin Initial Dosing Guidelines_2019 update Author: al118109 Created Date: 3/10/2020 11:49:56 A Evidence-based Guideline for Therapeutic Drug Monitoring of Vancomycin: 2020 Update by the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society Although 3 studies showed that vancomycin dosing based on actual weight (15-20 mg/kg, Development and evaluation of vancomycin dosage guidelines designed to achieve new. Objective: Current vancomycin monitoring guidelines recognize area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio as the target efficacy parameter for vancomycin. Despite the historical use of trough-only dosing as a surrogate marker for the AUC/MIC ratio, recent studies have challenged this strategy's efficacy and safety
Use Adjusted Body Weight for patients >120% of Ideal Body Weight. Recommend loading dose (20-25 mg/kg IV x1) for serious infections including CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis. Use Vancomycin Dosing Calculator (Excel file) for more precise dose calculation and level-based adjustment Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC) From 2009-2020, guidelines for vancomycin dosing were available through a joint effort from the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Society of Infectious Diseases Pharmacists (SIDP). 1 Despite availability of these guidelines and over 50 years of clinical experience. In hospitals, vancomycin dosing and monitoring is kind of a big deal. It involves prescribers, pharmacists, nurses, lab, and others. Prior to the vancomycin guideline just published in 2020, the previous vancomycin guideline was from 2009. Now over 10 years later, this latest iteration of the vancomycin guideline is recommending some pretty. The vancomycin dosage for intrapartum GBS prophylaxis should be based on weight and baseline renal function (20 mg/kg intravenously every 8 hours, with a maximum of 2 g per single dose.) Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth
BICU Antibiotic Stewardship Guidelines 4 b. July to December medication dosing i. Vancomycin: use vancomycin dosing advisor for recommendations ii. Cefepime 1. CrCl > 60 = 2grams q8h 2. CrCl 30-60 = 2grams q12h 3. CrCl 11-29 = 2grams q24h 4. CrCl < 11 = 1gram q24h IV. References 1 Issues related to parenteral vancomycin dosing and serum concentration monitoring in adult patients will be reviewed here, including guidelines on therapeutic monitoring published in 2020 by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Disease Society, and the Society of. Guidelines Therapeutic Monitoring of Vancomycin for MRSA Guidelines, 2020. Rybak et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of.
Issue Date: June 2017 Review Date: June 2020 Version: 7 Approved by: Medicines Policy Group (for DTC) Vancomycin concentration Suggested dose change <10 mg/L Increase the dose by 50% and consider reducing the dosage interval or seek advice 10 - 15 mg/L If the patient is responding, maintain the present dosage regimen The 2020 revised American consensus guidelines on vancomycin dosing and monitoring in patients with infections with methicillin-resistent Staphylococcus aureus support a ratio of the 24-h area under the concentration-time curve to the minimum inhibitory concentration of the suspected pathogen (AUC/MIC) of 400-600 mg·h/L for a favorable. . Vancomycin Dosing Guidelines: Where Do We Go From Here? Vancomycin has been in clinical use for more than 60 years and remains one of the most widely used antimicrobials in the inpatient setting. A link to this article will be included in this email. Recipient's Email Address
the 2009 vancomycin guidelines; this brings us to another chapter in vancomycin's story with the 2020 publication of revised vancomycin consensus guidelines that primar-ily focus on dosing vancomycin by the AUC/MIC ratio instead of trough monitoring.9 These updated guidelines further delineate appropriate vancomycin dosing for effi 2009 Vancomycin Guidelines 11 Rybak et al. Am J Health Syst Pharm. 2009 Vancomycin is a concentration-independent killer of gram-positive pathogens • AUC/MIC is the most useful PK/PD parameter to predict efficacy Trough serum vancomycin concentrations considered most practical method for monitoring • Drawn at steady state, just before 4th dos POSTED :NOVEMBER 2, 2020. Vancomycin Dosing Guidelines: Where Do We Go From Here? Vancomycin has been in clinical use for more than 60 years and remains one of the most utilized antimicrobials in the inpatient setting. A link to this article will be included in this email
2009 Vancomycin Guidelines. 11. Rybak et al. Am J Health Syst Pharm. 2009. Vancomycin is a . concentration-independent . killer of gram-positive pathogens • AUC/MIC is the most useful PK/PD parameter to predict efficacy. Trough serum vancomycin concentrations considered most practical method for monitoring • Drawn at steady state, just. . Newborn use only. 2020 . ANMF consensus group Vancomycin - Intermittent Page 4 of 7 . Pharmacokinetic studies demonstrate variability, which is only in part explained by weight, age, o Updated October 2020: COVID-19 section. Addition of amoxicillin-clavulanate IV and fosfomycin IV to Antibiotic sections. Updated September 2020: Vancomycin dosing and monitoring guidelines. Empiric therapy of SSTI in adult patients, particularly B-lactam allergy regimens to decrease use of clindamycin and fluoroquinolones wherever possible Table 1 summarizes vancomycin dosing for these infections. The new guideline incorporates pediatric patients, while the old guideline included only adults.3,4 The Tech Talk Sidebar (page 3) explains terms used throughout this activity. 2020 Guideline Overview The 2020 guideline provides specific recommendations regard Monitoring Vancomycin in Serious MRSA Infections. March 24, 2020. Marilyn N. Bulloch PharmD, BCPS, FCCM. The new guidelines recommend dosing vancomycin to achieve an area under the curve to minimum inhibitor concentration (AUC/MIC) ratio of ≥ 400. For the first time in 11 years, an updated consensus guideline on the therapeutic monitoring of.
Vancomycin has been used in clinical practice for over 60 years, but uncertainty still exists about its optimal use as clinicians seek to maximize efficacy and minimize toxicity. A consensus review published in 2009  summarized the following: (a) clinical effectiveness is best achieved when targeting the ratio of the area under the serum drug concentration-versus-time curve (AUC) and the. Obtain Vancomycin level prior to the third hemodialysis session: adjust vancomycin dose to maintain vancomycin pre-hemodialysis serum concentration between 15 to 20 mcg/mL Updated 07.01.2020 Issue 18 - October 2020 Update on Vancomycin Monitoring (For d osing recommendations , refer to . B ug s & Drugs) BOT TOM LINE: 1. AUC:MIC-based vancomycin monitoring/dosage adjustment is not recommended in AHS. 2. AHS endorses vancomycin trough based monitoring with recommended steady-state target vancomycin trough range of 10-20 mg/L. 3
Vancomycin Dosing . The Most Signiﬁcant Changes in the 2020 IDSA Vancomycin Guidelines • Individualized target of the AUC24/MIC BMD ratio of 400-600 should be advocated to achieve clinical efﬁcacy while improving patient safety (IIA) • AUC-guided dosing and monitoring is the most accurate and optimal way t Last updated: 13 July 2020. The long awaited vancomycin dosing and monitoring guideline update for treating serious methicillin-resistant Staphylococcus aureus (MRSA) infections was recently published in June 2020, over a decade since the initial 2009 guideline. In this update a primary recommendation includes moving from routine monitoring based on vancomycin trough levels toward area under. Methods and Results: This is the executive summary of the new vancomycin consensus guidelines for dosing and monitoring vancomycin therapy and was developed by the American Society of Health-Systems Pharmacists, Infectious Diseases Society of America, Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. The objective of this guideline is to improve the use of vancomycin by optimizing the evaluation of the clinical necessity for vancomycin therapy, dosing of vancomycin dosing based on pharmacodynamic and pharmacokinetic principles and parameters, and the monitoring of vancomycin, including therapeutic drug monitoring. Target Population
Table 2: Antimicrobial Dosing by Age and Phase of Care a Dosing guidelines are provided for patients with normal renal function. Consult pharmacist for guidance on modification for impaired renal function. b Monitor vancomycin trough before 4 th dose, adjust regimen per clinical pharmacist recommendations This calculator uniquely uses the 2020 vancomycin guideline recommendation for a population CL estimate derived from obese patients (Crass et al, JAC 2018). It will help decrease the risk of overdosing them compared to conventional 15mg/kg q12h initial dosing. o Considerations and caveats For most indications, target AUC is 400-600 Vancomycin Monitoring and Dosing Guideline Contact your local laboratory for hours of service or visit MyHealth.Alberta.ca Version: 1.2 Effective Date: 26 November 2018 RCCGNR15154 Edmonton Zone Chemistry Page 2 of 2 Infection Desired Trough Level (mg/L) Osteomyelitis 15-20 Pneumonia CNS infections.
The 2020 guideline for therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus (MRSA) infections created sweeping changes compared to the 2009 guideline with the recommendation to utilize area under the curve (AUC)-based rather than trough-based monitoring. 1,2. Estimating AUC using 2-point measurements or Bayesian software is recommended, but each pose. This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. We conducted our analysis using the MEDLINE, Web of Sciences, and Cochrane Register of Controlled Trials electronic databases searched on August 9, 2020. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) The guidelines also do not apply to MRSA infections for which the vancomycin MIC is known to be greater than 1 µg/mL by broth microdilution. Q. When doing AUC monitoring, why is it recommended to assume a vancomycin MIC of 1 µg/mL? A. Vancomycin MIC depends on the method used to measure it
Antibiotic Guidelines 2020 These are empirical guidelines - treatment should be reviewed clinically at 48-72 hours with the results of clinical findings, pathology and imaging results, and microbiological cultures. Antimicrobials can then be stopped, switched to oral therapy, changed to a narrow spectrum agent or continued with further review 2020 Vancomycin Dosing Guidelines from ASHP/IDSA/PIDS/SIDP. Nephrology strategy for dosing vancomycin in hemodialysis patients. Peritoneal Dialysis Antimicrobial Dosing Recommendations. Allergy and Immunology. Cardiovascular Medicine. Diabetes, Endocrinology, and Metabolism (DEM) Gastroenterology and Hepatology (GI) General Internal Medicine The revised consensus guidelines for TDM of vancomycin recommend AUC-guided dosing and monitoring for patients with suspected or definitive serious MRSA infections. 9 However, implementation of AUC monitoring is challenging in routine clinical practice (ie, investment in Bayesian software, training and education of pharmacists, physicians.
However, infections due to S. aureus with a vancomycin MIC ≥ 2 mcg/mL (≥ 1.4 micromol/L) may respond suboptimally to standard dosing even when the daily AUC is 400 to 600, so the threshold for changing to an alternative therapy should be low for patients with poor clinical response and an MIC of ≥ 2 Use of trough vancomycin concentrations is the most accurate and practical method to guide vancomycin dosing. Serum trough concentrations should be obtained at steady state conditions, before the. Constraints were placed on the dose strengths, the length of the dosing intervals, and the maximum infusion rate. In addition, flexibility with respect to the timing of the first maintenance dose was included in the optimization process. The GA-based optimal solution is compared with the Scottish Antimicrobial Prescribing Group vancomycin.
The guideline provides recommendations on vancomycin starting dose which for children was 15 mg/kg every 6 h or 8 h with lower dosing if reduced kidney function was present (i.e. estimated glomerular filtration rate < 75 ml/min/1.73m 2) (Frymoyer et al., 2009; Frymoyer et al., 2010; Liu et al., 2011) to successfully manage vancomycin dosing for patients 3. Abbreviations IBW Ideal body weight. ABW. Actual body weight, also known at total body weight (TBW) DBW. Dosing body weight - this is a term used in Epic for the actual patient weight of when starting an oncology therapy plan. In should not b The following links provide antimicrobial treatment and dosing guidelines for adults with various infectious diseases. These guidelines have been developed by CAUSE and approved by the CAUSE Advisory Board and the Pharmacy and Therapeutics Committee. As always, sound clinical judgement should be applied in conjunction with the information. SAN FRANCISCO, July 8, 2020 /PRNewswire/ -- For the first time since 2009, consensus guidelines for vancomycin dosing were published in March 2020 by four pharmacy and infectious disease.
A Canadian perspective on the revised 2020 ASHP-IDSA-PIDS- SIDP guidelines for vancomycin AUC-based therapeutic drug . monitoring for serious MRSA infections. Jackson J Stewart BSc(Pharm), ACPR. 1, Sarah CJ Jorgensen PharmD, MPH. 2, Linda Dresser BScPhm, PharmD, ACPR, FCSHP. 3,4, Tim TY Lau BSc(Pharm), PharmD, ACPR, FCSHP. 5,6,7 Info: dose, duration varies w/ pathogen susceptibility, valve type; may be part of multi-drug regimen incl. gentamicin gram positive synergy; refer to AHA guidelines; consider start 20-35 mg/kg/dose IV x1 in seriously ill pts, max 3 g/dose; use ABW to calculate dose; adjust dose based on serum levels; consider 20-25 mg/kg/dose IV x1 then 10-15.
Vancomycin dosing and monitoring recommendations are poorly adhered to in many institutions internationally, with concerns of treatment failure and propelling antibiotic resistance. The primary aim of this study was to audit the rate of adherence to American guidelines, with particular interest in loading dose administration Practice Guidelines. IDSA Clinical Practice Guidelines are developed by a panel of experts who perform a systematic review of the available evidence and use the GRADE process to develop evidence-based recommendations to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. IDSA. Population kinetics estimates a volume of distribution (Vd) of ~0.7 L/kg. Because of this distribution, we dose vancomycin based on total (actual) body weight in non-obese patients. In obese patients, consider use of adjusted body weight instead and/or lowering the Vd estimate (0.5-0.6 L/kg). Vancomycin is cleared via the kidneys When: Thursday, September 24, 2020, 6:00 - 8:00 pm Cost: FREE to members. UAN 0139-0000-20-205-L04-P (2.0 CPE Hour) Knowledge-Based Activity Target Audience: Pharmacists. Learning Objectives: Discuss the rationale for implementing AUC dosing with vancomycin
AUC is the preferred method of vancomycin dosing per the new 2020 clinical practice guidelines, but has not been widely adopted because many healthcare systems do not own the computer software. A second method, trough-only dosing , uses serial measurements of vancomycin trough levels to guide the dosing regimen The maximum recommended dose for adult or pediatric patients is 100mg/kg/day or 6 grams/day. Patients should have vancomycin troughs and serum creatinine drawn on a weekly basis while on therapy. References 1. Pediatric Dosage Handbook, 15th Edition, 2008 2. Frymoyer A et al. Current Recommended Dosing of Vancomycin for Children Wit . ISPD Secretariat Avenue des Arts 1-2 B-1210 Brussels - Belgium Phone: +32 2 808 04 20 / +1 567 251 401
Guidelines . Oral vancomycin prophylaxis (OVP) is a proposed method for primary and secondary prevention of CDI. A 2020 systematic review and meta-analysis published by Babar et al. summarizes available literature through March 2019 on the use of OVP in both primary and secondary prevention of Oral vancomycin dosing varied among the. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin.