Validity of 2020 vancomycin consensus recommendations and further guidance for practical application

We reviewed with interest the comments of Schulz and colleagues regarding pragmatic application of area under the curve–based monitoring recommendations from the 2020 vancomycin consensus guideline.1 Schultz et al correctly acknowledge that the purpose of the recommendation for area under the curve (AUC)–guided dosing and monitoring was to minimize vancomycin-associated acute kidney injury (VA-AKI) while maintaining efficacy against serious methicillin-resistant Staphylococcus aureus (MRSA) infections.1 Although highly debated in the past,2 the data demonstrate that the extent of VA-AKI increases as a function of the daily AUC, and that most events occur after 4 to 5 days of vancomycin therapy....