Vancomycin, a vital antibiotic for treating gram-positive bacterial infections, requires therapeutic drug monitoring (TDM) because of its substantial pharmacokinetic variability. While traditional TDM relies on steady-state trough concentrations, recent guidelines advocate the area under the concentration-time curve (AUC) as the target index. However, detailed protocols for AUC estimation are lacking, leading to potential discrepancies among institutions. We surveyed medical institutions in Korea regarding vancomycin TDM, including AUC estimation. Nineteen participants responded to the TDM case challenge under three patient scenarios. For an ordinary patient in Case 1, the overall CV for AUC values was 0.4% when both trough and peak concentrations were included in the AUC calculation and 1.9% when utilizing only the trough concentration. For Case 2, an older patient with obesity, the corresponding CV was 6.6%. For Case 3 with multiple trough concentrations, the CV was 15.6%, reflecting variations in the selective use of data. Although the agreements in Case 1 were good, significant variability in AUC estimation was noted in cases involving atypical patient characteristics or old TDM data. Our study provides insight into the current status of vancomycin TDM in Korea and underscores the need for standardized operational protocols for AUC estimation.

中文翻译：

---

韩国浓度-时间曲线估计下万古霉素面积的机构间比较：治疗药物监测咨询标准化操作方案的需要。


万古霉素是治疗革兰氏阳性细菌感染的重要抗生素，由于其显着的药代动力学变异性，需要治疗药物监测 (TDM)。虽然传统的 TDM 依赖于稳态谷浓度，但最近的指南主张将浓度-时间曲线下的面积 (AUC) 作为目标指标。然而，缺乏 AUC 估计的详细协议，导致机构之间可能存在差异。我们对韩国的医疗机构进行了有关万古霉素 TDM 的调查，包括 AUC 估算。 19 名参与者在三种患者场景下回答了 TDM 病例挑战。对于案例 1 中的普通患者，当 AUC 计算中同时包含谷浓度和峰浓度时，AUC 值的总体 CV 为 0.4%，而当仅使用谷浓度时，AUC 值的总体 CV 为 1.9%。对于案例 2，一名老年肥胖患者，相应的 CV 为 6.6%。对于具有多个谷浓度的案例 3，CV 为 15.6%，反映了数据选择性使用的变化。尽管案例 1 的一致性很好，但在涉及非典型患者特征或旧 TDM 数据的案例中，AUC 估计存在显着差异。我们的研究深入了解了韩国万古霉素 TDM 的现状，并强调了 AUC 估算标准化操作方案的必要性。