Is Peak Concentration Needed in Therapeutic Drug Monitoring of Vancomycin? A Pharmacokinetic-Pharmacodynamic Analysis in Patients with Methicillin-Resistant <b><i>Staphylococcus aureus </i></b>Pneumonia

Abstract

<b><i>Background:</i></b> We analyzed the pharmacokinetic-pharmacodynamic relationship of vancomycin to determine the drug exposure parameters that correlate with the efficacy and nephrotoxicity of vancomycin in patients with methicillin-resistant <i>Staphylococcus aureus</i> pneumonia and evaluated the need to use peak concentration in therapeutic drug monitoring (TDM). <b><i>Methods:</i></b> Serum drug concentrations of 31 hospitalized patients treated with vancomycin for methicillin-resistant <i>S. aureus</i> pneumonia were collected. <b><i>Results:</i></b> Significant differences in trough concentration (C<sub>min</sub>)/minimum inhibitory concentration (MIC) and area under the serum concentration-time curve (AUC<sub>0–24</sub>)/MIC were observed between the response and non-response groups. Significant differences in C<sub>min</sub> and AUC<sub>0–24</sub> were observed between the nephrotoxicity and non-nephrotoxicity groups. Receiver operating characteristic curves revealed high predictive values of C<sub>min</sub>/MIC and AUC<sub>0–24</sub>/MIC for efficacy and of C<sub>min</sub> and AUC<sub>0–24</sub> for safety of vancomycin. <b><i>Conclusions:</i></b> These results suggest little need to use peak concentration in vancomycin TDM because C<sub>min</sub>/MIC and C<sub>min</sub> are sufficient to predict the efficacy and safety of vancomycin.