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The following is a summary of “Vancomycin Monitoring for Treatment of Acute Pulmonary Exacerbations of Adult Cystic Fibrosis Patients,” published in the May 2025 issue of Pulmonary Medicine by Smith et al.
Researchers conducted a retrospective study to compare vancomycin (VAN) trough and area under the curve (AUC) monitoring for reducing acute kidney injury (AKI) risk in adult people with cystic fibrosis.
They assessed 143 adult pwCF admitted between July 1, 2017, and July 1, 2022, for acute pulmonary exacerbation who received VAN for at least 72 hours with available plasma concentrations for therapeutic drug monitoring (TDM) using AUC (n = 39) or trough levels (n = 104). Multiple hospital admissions per patient were treated as separate encounters. The primary outcome measured was the incidence of AKI.
The results showed that concurrent nephrotoxin use was higher in the AUC group than the trough group (97% vs 81%, P= 0.01), while acute kidney injury rates were comparable (7.7% vs 10.6%, P= 0.76) and AUC monitoring led to faster attainment of TDM goals (median 0 days [IQR 0–2] vs 2 days [IQR 0–4], P< 0.01), lower total daily VAN doses (34.8 mg/kg/day [IQR 27.6–49] vs 57.5 mg/kg/day [IQR 43.9–68.6], P< 0.01), and fewer dosage adjustments (median 1 change [IQR 0–2] vs 2 changes [IQR 1–3], P< 0.01). Among patients with MRSA, pulmonary function improvement, readmission rates, and mortality were similar between groups.
Investigators concluded that in adult pwCF, AKI incidence was comparable between AUC and trough monitoring, while the AUC monitoring reached therapeutic targets faster with fewer regimen changes and no significant increase in concentration measurements.
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