ArticleAntimicrobial agents and chemotherapy2014
Are vancomycin trough concentrations adequate for optimal dosing?
Article in Antimicrobial agents and chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04758442 (Optimal Dosing of Vancomycin in an Adult Population of Hemato-oncology), which is not on this map. Cited by 183 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Optimal Dosing of Vancomycin in an Adult Population of Hemato-oncology: a Nomogram Based on a Bayesian Population Model to Predict Initial Dosage of Vancomycin
Who cites it
183 citing papers in PubMed, 6 syntheses or guidelines pooled it, 381 citations in OpenAlex.
- Impact of Extracorporeal Membrane Oxygenation Life Support on Vancomycin Population Pharmacokinetics in Critical Illness: A Systematic Review.Clinical drug investigation · 2025Pooled it
- Systematic review and meta-analysis of vancomycin therapeutic level for treatment of vancomycin-sensitive enterococcal infections.British journal of clinical pharmacology · 2025Pooled it
- Vancomycin area under the curve versus trough only guided dosing and the risk of acute kidney injury: Systematic review and meta-analysis.Pharmacotherapy · 2022Pooled it
- The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing.BMC infectious diseases · 2021Pooled it
- Vancomycin Area Under the Curve and Acute Kidney Injury: A Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Pooled it
- Association between the AUC0-24/MIC Ratio of Vancomycin and Its Clinical Effectiveness: A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- Big Data Bayesian Truths: No Vancomycin Trough Concentration Target Is Sufficiently Precise for Safety or Efficacy.Open forum infectious diseases · 2025Trial
- Implementation of a Pharmacist-Driven Vancomycin Area Under the Concentration-Time Curve Monitoring Program Using Bayesian Modeling in Outpatient Parenteral Antimicrobial Therapy.Open forum infectious diseases · 2024Trial
- Population Pharmacokinetics of Vancomycin in Critically Ill Adult Patients Receiving Extracorporeal Membrane Oxygenation (an ASAP ECMO Study).Antimicrobial agents and chemotherapy · 2022Trial
- Clinical and Pharmacokinetic Outcomes of Peak-Trough-Based Versus Trough-Based Vancomycin Therapeutic Drug Monitoring Approaches: A Pragmatic Randomized Controlled Trial.European journal of drug metabolism and pharmacokinetics · 2019Trial
- Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing.Antimicrobial agents and chemotherapy · 2018Trial
- Population pharmacokinetics and pharmacodynamics of teicoplanin in neonates: making better use of C-reactive protein to deliver individualized therapy.The Journal of antimicrobial chemotherapy · 2016Trial
- Daptomycin Improves Outcomes Regardless of Vancomycin MIC in a Propensity-Matched Analysis of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections.Antimicrobial agents and chemotherapy · 2016Trial
- Theophylline Population Pharmacokinetics and Dosing in Children Following Congenital Heart Surgery With Cardiopulmonary Bypass.Journal of clinical pharmacology · 2016Trial
- Multisite Analysis of Vancomycin Concentration Predictions in a Bayesian Software in Adult and Pediatric Patients With and Without Acute Kidney Injury.Pharmacotherapy · 2026Article
- Comparison of Bayesian and First-Order Estimations of Vancomycin Area Under the Curve in Pediatrics Using One- and Two-Concentration Methods.Pharmacotherapy · 2026Article
- PK/PD study of vancomycin in enterococcal infections: efficacy and safety assessment under the guidance of TDM.Microbiology spectrum · 2026Observational
- Defining Optimal Sampling Strategies for Cefepime Model-Informed Precision Dosing.Therapeutic drug monitoring · 2026Article
- Model-informed precision dosing of vancomycin in children 3 months to 18 years of age using Australia-wide data.Antimicrobial agents and chemotherapy · 2026Article
- Dual therapeutic interventions to optimize vancomycin exposure and reduce nephrotoxicity: a cohort study from a single center.BMC nephrology · 2026Article
123 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
Abstract
The current vancomycin therapeutic guidelines recommend the use of only trough concentrations to manage the dosing of adults with Staphylococcus aureus infections. Both vancomycin efficacy and toxicity are likely to be related to the area under the plasma concentration-time curve (AUC). We assembled richly sampled vancomycin pharmacokinetic data from three studies comprising 47 adults with various levels of renal function. With Pmetrics, the nonparametric population modeling package for R, we compared AUCs estimated from models derived from trough-only and peak-trough depleted versions of the full data set and characterized the relationship between the vancomycin trough concentration and AUC. The trough-only and peak-trough depleted data sets underestimated the true AUCs compared to the full model by a mean (95% confidence interval) of 23% (11 to 33%; P = 0.0001) and 14% (7 to 19%; P < 0.0001), respectively. In contrast, using the full model as a Bayesian prior with trough-only data allowed 97% (93 to 102%; P = 0.23) accurate AUC estimation. On the basis of 5,000 profiles simulated from the full model, among adults with normal renal function and a therapeutic AUC of ≥400 mg · h/liter for an organism for which the vancomycin MIC is 1 mg/liter, approximately 60% are expected to have a trough concentration below the suggested minimum target of 15 mg/liter for serious infections, which could result in needlessly increased doses and a risk of toxicity. Our data indicate that adjustment of vancomycin doses on the basis of trough concentrations without a Bayesian tool results in poor achievement of maximally safe and effective drug exposures in plasma and that many adults can have an adequate vancomycin AUC with a trough concentration of <15 mg/liter.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.