Reassessing predialysis goals for serious methicillin-resistant Staphylococcus aureus infections

The updated vancomycin guideline for 2020 is a welcome change in the safe and effective dosing of vancomycin. The focus on area under the curve (AUC) allows for a more holistic clinical decision-making process in comparison to trough monitoring alone.1 However, there appears to be a discrepancy with the recommendation for the optimal monitoring of vancomycin in patients on dialysis that needs to be clarified. The authors state that predialysis vancomycin concentrations of 10 to 20 mg/L result in a mean AUC of 250 to 450 mg · h/L and then recommend predialysis concentrations of 15 to 20 mg/L to achieve an AUC of 400 to 600 mg · h/L in the 24 hours before dialysis.1,2 This is contradictory because AUC in the previous 24 hours will always be lower than mean AUC over 24 hours when the dosing frequency is more than 24 hours. Moreover,...