Vancomycin Dosing Regimen to Obtain the Target Area Under the Concentration–Time Curve, Which Provides an Early Treatment Response for Patients on Haemodialysis

Objectives: This study aimed to clarify the area under the curve (AUC) for obtaining better clinical outcomes and to demonstrate vancomycin dosing for achieving the AUC in haemodialysis (HD). Methods: The vancomycin concentration was measured before the second HD. The AUC24–48h after the initial HD was assessed to evaluate its correlation with an early clinical response and to determine the dosing regimen, assuming an inter-dialysis interval of 48 h, even if the interval was 72 h. Results: An AUC/MIC ≥ 400 was an independent factor for an early response in treating MRSA infections and infections caused by methicillin-resistant Gram-positive organisms. An AUC of 600–700 μg·h/mL did not increase the incidence of adverse effects compared with that of <600 μg·h/mL. An AUC of 400–700 μg·h/mL was obtained in 90.5% of patients with a loading dose of 30 mg/kg followed by a maintenance dose of 10 mg/kg. Pre-dialysis concentrations were significantly higher than the trough concentration required in non-HD patients to achieve the same AUC category, and AUC24–48h was strongly correlated with pre-dialysis concentrations (R2 = 0.921). In a receiver operating characteristic curve, the cut-off value for an early response was 16.8 μg/mL for the pre-dialysis concentration/MIC. Conclusions: AUC24–48h after the initial HD/MIC of ≥400 μg/mL improves the clinical outcomes in patients on HD, and the target PK/PD can be achieved with an upper range of the recommended dose. The pre-dialysis concentration may be a reliable surrogate for the AUC, and the vancomycin dose could be adjusted according to this PK target.