Estimating Vancomycin AUC Using Only Trough Levels in Pediatric Patients

Overview

This study evaluated 23 population pharmacokinetic models to estimate vancomycin 24-hour area under the curve (AUC24h) using only trough concentrations in pediatric patients. Results showed that trough-based AUC24h estimation had comparable precision to methods using both peak and trough levels, supporting its feasibility in clinical practice.

Background

Vancomycin is a critical antibiotic for treating methicillin-resistant Staphylococcus aureus infections in pediatric patients, especially in intensive care settings. Therapeutic drug monitoring (TDM) is essential to balance efficacy and toxicity, with AUC24h/MIC as the preferred pharmacodynamic target. Traditionally, trough concentrations were used as surrogates for AUC24h, but recent guidelines recommend direct AUC24h estimation using Bayesian methods. However, obtaining both peak and trough samples can be challenging in pediatrics, prompting evaluation of trough-only approaches.

Data Highlights

Key Findings

• Trough concentration–based AUC24h estimation showed similar precision (rRMSE) to peak and trough–based methods in both neonatal and older pediatric cohorts.
• In neonates (postnatal age <50 days), models by Chen, Colin, and Mehrotra had the lowest relative bias and highest precision.
• In older pediatric patients (postnatal age ≥50 days), Alsultan and Lv models performed best for trough-based AUC24h estimation.
• Using only trough concentrations simplifies sampling and reduces patient burden without compromising AUC24h estimation accuracy.
• Model-informed precision dosing (MIPD) software incorporating these models can facilitate individualized vancomycin dosing in pediatrics.

Clinical Implications

Clinicians can reliably estimate vancomycin AUC24h in pediatric patients using trough concentrations alone, facilitating easier and less invasive therapeutic drug monitoring. Adoption of validated population pharmacokinetic models for trough-based AUC estimation supports precision dosing and may improve safety and efficacy. Further studies correlating trough-based AUC estimation with clinical outcomes are warranted.

Conclusion

Trough-only vancomycin concentration sampling is a feasible and accurate approach for AUC24h estimation in pediatric patients using selected population pharmacokinetic models. This method supports the implementation of model-informed precision dosing to optimize vancomycin therapy in children.

References

1. Erasmus University Medical Centre Study 2023 -- Estimating Vancomycin Area Under the Curve Using Only Trough Levels