Vol.74 No.3 May 2026
Clinical evaluation of a nomogram for initial vancomycin dosing recommended in the 2022 Clinical Practice Guidelines for Therapeutic Drug Monitoring of Antimicrobials
1)Department of Pharmacy, Suita Tokushukai Hospital, 21-1 Senrioka-Nishi, Suita, Osaka, Japan
Abstract
The 2022 Clinical Practice Guidelines for Therapeutic Drug Monitoring (TDM) of Antimicrobials (GL 2022) recommend targeting a vancomycin (VCM) area under the concentration-time curve (AUC) of 400-600 μg·h/mL. The GL 2022 also provides a nomogram (Nomogram 2022) for determining the initial VCM dose based on the body weight and renal function.
In this study, we developed a modified nomogram based on Nomogram 2022. A total of 144 patients at Suita Tokushukai Hospital who received VCM dosing according to this modified nomogram were included. Steady-state AUC was calculated with the TDM software PAT using parameters obtained at the initial TDM. The target AUC of 400-600 μg·h/mL was achieved in 91 patients (63.2%), but not in the remaining 53 patients. Logistic regression analysis identified "skin and soft tissue infection" and a "creatinine clearance (Ccr) value of 50-59 mL/min with VCM 0.5 g administered every 12 h" as significant risk factors for an AUC below 400 μg·h/mL, and only a "Ccr value of 70-79 mL/min with VCM 1.0 g administered every 12 h" as a significant risk factor for an AUC above 600 μg·h/mL. The latter risk could be mitigated by interpreting the Ccr values in Nomogram 2022 such that 70 and 80 correspond to ranges of 70-79 and 80-89, respectively; similar interpretations may also be applicable to other Ccr values. These findings suggest that, particularly from a safety perspective, Nomogram 2022 is a highly versatile dosing tool applicable to a broad range of patient characteristics.
Key word
vancomycin, therapeutic drug monitoring, area under the concentration-time curve
Received
June 27, 2025
Accepted
January 22, 2026
Jpn. J. Chemother. 74 (3): 428-437, 2026
