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Comparison of the Incidence of Vancomycin-Associated Nephrotoxicity Between AUC-Guided and Trough-Guided Dosing in Elderly Patients Aged 75 Years

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This study aims to compare the incidence of vancomycin-associated nephrotoxicity between AUC-guided and trough-guided dosing in elderly patients.
Single center comparison of 257 trough-guided and 223 one-point AUC-guided dosing cases.
Tendency scores calculated from nephrotoxicity risk factors and matching performed to select 128 subjects in each group.
Evaluation of AUC and AKI occurrence in early and maintenance phases using trough concentrations.
Patients on AUC-guided dosing exceeded the AUC threshold > 600 µg·h/mL at a significantly lower rate (12.5% vs 26.6%, P = 0.007).
AUC-guided dosing substantially delayed AKI onset during the maintenance phase (HR 0.34 [95% CI: 0.13 – 0.87], P = 0.024).

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Randomized trial compares nephrotoxicity outcomes in elderly patients, suggesting AUC-guided dosing is safer.

Harada et al. (2026) studied this question.

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