You are here
Home > Medical Calculator > Vancomycin Advanced AUC Calculator

Vancomycin Advanced AUC Calculator (beta)

Co-developed by Matthew Girgis, PharmD, BCIDP trained in Boston, currently fighting drug resistant bugs in Toronto, Canada.

For single level dosing enter data under trough level below. Also include current dose and interval in the levels section if dosing by levels.

AUC Target:   0-24   Age:     Sex

Serum Creatinine
Height
:      Weight:

Some hospitals have requested the option to manually enter the CrCL:
  mL/min

Levels (if available) - Select option above first

Peak level:  mcg/mL  
Number hours post dose:   hrs
Trough level:  mcg/mL 
Number hours post dose:   hrs

Current dose being given:   mg
.   Current dosing interval: hrs

Empiric dosing only

Elimination rate constant:   Background information

Volume of Distribution:   Select Vd:led     L/kg
- Normal = 0.65
- Obese = 0.5
- Dehydrated = 0.6
- Overhydrated = 0.7-0.85
- Septic Shock/ICU/Trauma = 0.7-0.75
- Pregnant in 3rd Trimester or <48h post partum = 0.7

Amputations

Addition data required for further analysis.

Desired Peak:   mcg/ml    Desired Trough:   mcg/ml

Infusion time (ti): led   Info
[AUC guided recommendations will appear on the results page]





References



This latest version is based on a comprehensive review of the most recent pharmacokinetic textbooks. Some of the sources used are listed here
  1. Bauer LA. The Aminoglycoside Antibiotics. In Bauer LA, ed. Applied Clinical Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical; 2008:97-206.

  2. Bauer LA. Vancomycin. In Bauer LA, ed. Applied Clinical Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical; 2008:207-298.

  3. Burton ME, Shaw LM, Schentag JJ, Evans WE. Applied Pharmacokinetics & Pharmacodynamics: Principles of Therapeutic Drug Monitoring. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.

  4. DiPiro JT, Spruill WJ, Wade WE, Blouin RA, Pruemer JM. Concepts in Clinical Pharmacokinetics, (5th Edition) 2010. American Society of Health Systems Pharmacist, Bethesda, MD.

  5. Murphy JE. Aminoglycosides. In: Murphy JE, ed. Clinical Pharmacokinetics, 4th ed. Bethesda, MD: American Society of Health-System Pharmacists, 2008:27-60.

  6. Winter ME. Basic clinical pharmacokinetics. 5th ed. Baltimore: Lippincott Williams and Wilkins; 2010.

  7. Rybak MJ, Le J, Lodise TP,Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring of vancomycin: A revised consensus guideline and review of 1the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. Accessed: May 2019. [Link]
  8. Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy 2012; 32: 604-612 [PMID: 22576791 DOI: 10.1002/j.1875-9114.2012.01098.x]

    Quotes: [Largest study so far....total of 3678 patients]
    Regarding Salazar equation: This equation, however, was not consistently shown in studies to be a superior predictor of renal function. It is not widely used in clinical practice and has not been validated in pharmacokinetic studies. In addition, the Salazar-Corcoran equation is not recognized by the National Kidney Foundation.

    Regarding CG -LBW equation: Our findings do not support those conclusions and are different from a recent investigation of Clcr in 54 morbidly obese patients that found that adjusting an obese patient's weight to a fat-free weight or lean body weight predicted a Clcr calculated with the C-G equation without bias. Notably, our study included 2065 obese or morbidly obese patients, far more than other published studies. 

    Conclusions: An unbiased C-G Clcr can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW0.4 for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C-G Clcr. Rounding Scr in patients with low Scr did not improve accuracy or bias of the Clcr calculations.  top of page


Vancomycin Monitoring (ASHP 2020)

See source below for the complete guidelines.
"In patients with suspected or definitive serious MRSA infections, an individualized target of the AUC/MICBMD ratio of 400 to 600 (assuming a vancomycin MICBMD of 1 mg/L) should be advocated to achieve clinical efficacy while improving patient safety (A-II). Doses of 15 to 20 mg/kg (based on actual body weight) administered every 8 to 12 hours as an intermittent infusion are recommended for most patients with normal renal function when assuming a MICBMD of 1 mg/L (A-II). In patients with normal renal function, these doses may not achieve the therapeutic AUC/MIC target when the MIC is 2 mg/L."

"In patients with suspected or definitive serious MRSA infections, an individualized target of the AUC/MICBMD ratio of 400 to 600 (assuming a vancomycin MICBMD of 1 mg/L) should be advocated to achieve clinical efficacy while improving patient safety (A-II). Doses of 15 to 20 mg/kg (based on actual body weight) administered every 8 to 12 hours as an intermittent infusion are recommended for most patients with normal renal function when assuming a MICBMD of 1 mg/L (A-II). In patients with normal renal function, these doses may not achieve the therapeutic AUC/MIC target when the MIC is 2 mg/L."

"Based on current national vancomycin susceptibility surveillance data, under most circumstances of empiric dosing, the vancomycin MIC should be assumed to be 1 mg/L. When the MICBMD is >1 mg/L, the probability of achieving an AUC/MIC target of ≥400 is low with conventional dosing; higher doses may risk unnecessary toxicity, and the decision to change therapy should be based on clinical judgment. In addition, when the MICBMD is <1 mg/L, we do not recommend decreasing the dose to achieve the AUC/MIC target. It is important to note the limitations in automated susceptibility testing methods, including the lack of precision and variability in MIC results depending on method used (B-II)."

"Trough-only monitoring, with a target of 15 to 20 mg/L, is no longer recommended based on efficacy and nephrotoxicity data in patients with serious infections due to MRSA (A-II). There is insufficient evidence to provide recommendations on whether trough-only or AUC-guided vancomycin monitoring should be used among patients with noninvasive MRSA or other infections."

"A vancomycin loading dose of 20 to 25 mg/kg using actual body weight, with a maximum dose of 3,000 mg, may be considered in obese adult patients with serious infections (B-II). Initial maintenance doses of vancomycin can be computed using a population PK estimate of vancomycin clearance and the target AUC in obese patients. Empiric maintenance doses for most obese patients usually do not exceed 4,500 mg/day, depending on their renal function (B-II). Early and frequent monitoring of AUC exposure is recommended for dose adjustment, especially when empiric doses exceed 4,000 mg/day (A-II). Measurement of peak and trough concentrations is recommended to improve the accuracy of vancomycin AUC estimation and maintenance dose optimization in obese patients, aligning with recommendations 2 and 5 for nonobese adults."

Source: Rybak MJ, Le J, Lodise TP, Levine DP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2020 May 19;77(11):835-864. doi: 10.1093/ajhp/zxaa036. PMID: 32191793.
    [BMD]-  MIC determined by broth  microdilution


Related pharmacokinetic calculators


Trough Calculators


Allows the user to estimate the actual (extrapolated) trough based on the elimination rate constant and the number of hours the level was drawn before the next scheduled dose. A supratherapeutic level may be actually therapeutic if it was drawn just before the next dose. Trough drawn early? -Estimation Tool based on entered Kel
This new program can be used to determine when to administer the next dose of vancomycin after a supratherapeutic trough is obtained. An estimated elimination rate constant is generated from the creatinine clearance which is then used to determine the timing of the next dose based on the desired target trough concentration.
Vancomycin -Timing of next dose based on estimated Ke value

Use this program if the vancomcyin level is drawn early and you want to estimate the actual trough just before the next dose to determine if the current regimen is appropriate Vancomycin  Predicted Trough-Level drawn early

Dosing by levels


Dosing by levels (Full) Dosing by levels  pharmacokinetics (quick) Non-Steady State kinetics

Pharmacokinetics


Pharmacokinetics -Multiple Ke (Advanced version)Pharmacokinetic dosing -aminoglycosides/Vanco Original program

Vancomycin  Single-level dosing


Vancomycin SINGLE Level-(dosing by levels) Original calc led
If you would like to enter the time since the last dose was given, use this version. This new version may be especially useful if the trough was drawn late and thenext dose was delayed. Example: current regimen vanco 1 gram q12h. Trough wasdrawn 12.5 hours after the last dose.Vancomycin single-level  dose infused early or late

The GlobalRPh vancomycin single-level calculator uses the Vd recommended in Bauer's text: 0.7 L/kg. Use the advanced version if you wish to manipulate this value.Vancomycin single level Advanced version

Vancomycin Advanced AUC Calculator