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Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC).

Publication ,  Journal Article
Keil, E; Wrenn, RH; Deri, CR; Slaton, CN; Shroba, J; Parish, A; Erkanli, A; Spivey, J
Published in: Ann Pharmacother
August 2023

BACKGROUND: Vancomycin area-under-the-curve (AUC) monitoring is associated with reduced nephrotoxicity but may increase cost and workload for personnel compared to trough monitoring. OBJECTIVE: The purpose of this study was to compare the accuracy of vancomycin AUC calculated by open-access, online, trough-only calculators to AUCs calculated by the trapezoidal method (TM) using peak and trough concentrations. METHODS: This retrospective, multi-center study included adults ≥18 years old with stable renal function who received vancomycin with steady-state peak and trough concentrations. Areas under the curve calculated by TM were compared to AUCs calculated by 3 online calculators using trough-only options for calculation: ClinCalc, VancoVanco, and VancoPK. The primary outcome was actual difference in AUC between TM and the online calculators. Secondary outcomes were percent difference in AUC and clinical alignment in dose adjustments between methods. RESULTS: Seventy patients were included for analysis. There was a statistically significant difference in AUC between TM and ClinCalc (median actual difference: -52, P < 0.001) and VancoVanco (median actual difference: 95, P < 0.001), whereas there was no significant difference between TM and VancoPK (median actual difference: -0.8, P = 0.827). Discordant dose adjustments were indicated when comparing ClinCalc, VancoVanco, and VancoPK to TM in 28%, 36%, and 12% of cases, respectively. CONCLUSION: The AUC calculator most closely aligned with TM was VancoPK, whereas other included calculators were statistically different. Owing to the cost and complexity of obtaining multiple levels, our findings support using a single steady-state trough using VancoPK as an alternative to TM for calculation of vancomycin AUC.

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Published In

Ann Pharmacother

DOI

EISSN

1542-6270

Publication Date

August 2023

Volume

57

Issue

8

Start / End Page

940 / 947

Location

United States

Related Subject Headings

  • Vancomycin
  • Retrospective Studies
  • Pharmacology & Pharmacy
  • Microbial Sensitivity Tests
  • Humans
  • Area Under Curve
  • Anti-Bacterial Agents
  • Adult
  • Adolescent
  • 3214 Pharmacology and pharmaceutical sciences
 

Citation

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Keil, E., Wrenn, R. H., Deri, C. R., Slaton, C. N., Shroba, J., Parish, A., … Spivey, J. (2023). Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC). Ann Pharmacother, 57(8), 940–947. https://doi.org/10.1177/10600280221138867
Keil, Elizabeth, Rebekah H. Wrenn, Connor R. Deri, Cara N. Slaton, Jenny Shroba, Alice Parish, Alaattin Erkanli, and Justin Spivey. “Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC).Ann Pharmacother 57, no. 8 (August 2023): 940–47. https://doi.org/10.1177/10600280221138867.
Keil E, Wrenn RH, Deri CR, Slaton CN, Shroba J, Parish A, et al. Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC). Ann Pharmacother. 2023 Aug;57(8):940–7.
Keil, Elizabeth, et al. “Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC).Ann Pharmacother, vol. 57, no. 8, Aug. 2023, pp. 940–47. Pubmed, doi:10.1177/10600280221138867.
Keil E, Wrenn RH, Deri CR, Slaton CN, Shroba J, Parish A, Erkanli A, Spivey J. Comparison of Open-Access, Trough-Only Online Calculators Versus Trapezoidal Method for Calculation of Vancomycin Area Under the Curve (AUC). Ann Pharmacother. 2023 Aug;57(8):940–947.
Journal cover image

Published In

Ann Pharmacother

DOI

EISSN

1542-6270

Publication Date

August 2023

Volume

57

Issue

8

Start / End Page

940 / 947

Location

United States

Related Subject Headings

  • Vancomycin
  • Retrospective Studies
  • Pharmacology & Pharmacy
  • Microbial Sensitivity Tests
  • Humans
  • Area Under Curve
  • Anti-Bacterial Agents
  • Adult
  • Adolescent
  • 3214 Pharmacology and pharmaceutical sciences