Phân tích kết quả hiệu chỉnh liều vancomycin theo AUC trên bệnh nhân người lớn tại Bệnh viện Phổi Trung ương

Vancomycin remains a cornerstone in treating severe Gram-positive bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA). However, its highly variable pharmacokinetics necessitate precise dosage adjustment to maximize efficacy and safety while mitigating drug resistance. Contemporary guidelines increasingly advocate for Area Under the Curve (AUC)-guided therapeutic drug monitoring (TDM) using Bayesian methods, moving beyond traditional trough concentration monitoring. This approach is critical for optimizing patient outcomes, particularly in vulnerable populations. This study, conducted at the National Lung Hospital, aims to analyze the implementation results of an AUC-guided vancomycin dosing protocol and identify factors influencing the achievement of target AUC, thereby contributing to the rational and effective use of this vital antibiotic.

Clinical pharmacists, physicians specializing in infectious diseases or critical care, and researchers in clinical pharmacology.

This study investigated the effectiveness of an AUC-guided vancomycin dosing protocol, incorporating therapeutic drug monitoring (TDM) and Bayesian methods, in adult patients at the National Lung Hospital. The primary objective was to assess the protocol's implementation outcomes and identify factors contributing to subtherapeutic vancomycin exposure (AUC < 400 mg·h/L) during initial measurements. A retrospective, descriptive analysis was performed on the medical records of 93 adult inpatients receiving intravenous vancomycin between January and September 2024. The Bayesian method, facilitated by SmartDoseAl software, was used to estimate vancomycin AUC, targeting a range of 400-600 mg·h/L, with dose adjustments made as needed. Results showed that initially, 52.7% of patients achieved the target AUC. This proportion significantly improved to 83.5% after the first dose adjustment and re-assessment. Overall, 69.9% of patients achieved the target AUC at least once during treatment. Logistic regression analysis identified that an initial maintenance dose lower than the protocol's recommendation was an independent predictor of subtherapeutic exposure, increasing the risk by 4.58 times (p=0.007). Notably, the incidence of renal adverse events was low at 6.5%. The findings underscore that implementing an AUC-guided vancomycin dosing protocol, particularly when utilizing Bayesian methods for dose adjustment, substantially enhances the probability of achieving therapeutic targets. This approach not only optimizes treatment efficacy but also appears to minimize adverse effects, affirming the value of robust TDM practices. The study emphasizes the critical importance of strict adherence to TDM protocols and the administration of appropriate initial maintenance doses to ensure earlier target attainment and improved patient outcomes in vancomycin therapy.