title: Is peak concentration needed in therapeutic drug monitoring of vancomycin? A pharmacokinetic-pharmacodynamic analysis in patients with methicillin-resistant staphylococcus aureus pneumonia.
abstract: BACKGROUND
  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 Staphylococcus aureus pneumonia and evaluated the need to use peak concentration in therapeutic drug monitoring (TDM).
  
  
  METHODS
  Serum drug concentrations of 31 hospitalized patients treated with vancomycin for methicillin-resistant S. aureus pneumonia were collected.
  
  
  RESULTS
  Significant differences in trough concentration (Cmin)/minimum inhibitory concentration (MIC) and area under the serum concentration-time curve (AUC0-24)/MIC were observed between the response and non-response groups. Significant differences in Cmin and AUC0-24 were observed between the nephrotoxicity and non-nephrotoxicity groups. Receiver operating characteristic curves revealed high predictive values of Cmin/MIC and AUC0-24/MIC for efficacy and of Cmin and AUC0-24 for safety of vancomycin.
  
  
  CONCLUSIONS
  These results suggest little need to use peak concentration in vancomycin TDM because Cmin/MIC and Cmin are sufficient to predict the efficacy and safety of vancomycin.
authors.affiliation: Department of Clinical Pharmacy, Oita University Hospital, Oita, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Kanako
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Yuhki
authors.initials: Y
authors.lastname: Sato
authors.forename: Issei
authors.initials: I
authors.lastname: Tokimatsu
authors.forename: Hiroki
authors.initials: H
authors.lastname: Itoh
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Masaharu
authors.initials: M
authors.lastname: Takeyama
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D019540:Area Under Curve; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology; D012372:ROC Curve; D012189:Retrospective Studies; D014640:Vancomycin / Q000097:blood / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin