Clinical Feasibility of Nomogram-Based Vancomycin Dosing Strategy: A Retrospective Study

Abstract

Vancomycin (VCM) dosing based on the area under the concentration–time curve (AUC)–guided therapeutic drug monitoring is recommended to optimize efficacy and safety; however, pharmacokinetic simulation software is not always available in routine clinical practice. This retrospective study evaluated the usefulness of an AUC-guided nomogram as an alternative approach for VCM dosing strategy. Hospitalized patients who underwent initial VCM serum concentration measurements were categorized into software, nomogram, or non-intervention groups according to VCM dosing strategy. Attainment of pharmacokinetic indices, including first-day AUC (AUC_f24) and safety outcomes, was compared among the groups. The nomogram group demonstrated a significantly higher percentage of achieving the target AUC_f24 (55.4%) than the non-intervention group (30.8%) and achieved target attainment comparable to that of the software group (62.0%). Multivariable logistic regression analysis with nomogram-based VCM dosing as the reference identified non-intervention to dosing strategy as a factor associated with failure to achieve the target AUC_f24 (odds ratio; 2.82, 95% confidential interval; 1.21, 6.54). The incidence of acute kidney injury did not differ significantly among the groups. In the subgroup of patients with Gram-positive bacteremia, the duration of 50% decrease in C-reactive protein differed significantly among the three groups, with shorter durations observed in the nomogram (median; 4 d) and software groups (median; 4 d) than those in the non-intervention group (median; 9 d). These findings indicate that a nomogram-based VCM dosing strategy can facilitate early attainment of pharmacokinetically appropriate VCM exposure and may serve as a feasible alternative to a software-based VCM dosing strategy.