Vancomycin Dose Adjustment Guided by Therapeutic Drug Monitoring in Adult Patients at Phenikaa University Hospital

Abstract

Objective: To describe the real-world implementation of vancomycin therapeutic drug monitoring (TDM) based on area under the concentration–time curve (AUC) estimation and dose adjustment in adult patients at Phenikaa University Hospital. Methods: A retrospective observational study was conducted using medical records of adult patients who were prescribed vancomycin from July 2025 to March 2026. Data collected included patient characteristics, microbiological findings, vancomycin utilization and concomitant medications, nephrotoxicity, as well as TDM practices. Dose adjustments were performed based on AUC estimation using SmartDoseAI® software, with a therapeutic target of AUC 400–600 mg·h/L. Results: A total of 62 patients receiving vancomycin were included, of whom 43 underwent TDM and dose adjustment. The proportion of patients receiving appropriate loading doses and initial maintenance doses in accordance with the hospital’s vancomycin TDM protocol was 93.5%. Vancomycin was predominantly prescribed empirically. Renal function was monitored at least once weekly in 85% of patients. Among the 43 patients analyzed, the proportion achieving target AUC increased significantly from 53.5% to 81.4% after the first dose adjustment. Further studies are warranted to optimize and individualize loading and initial maintenance dosing to improve early target attainment. Conclusion: Compliance with loading and initial maintenance dosing was generally good at Phenikaa University Hospital. TDM and vancomycin dose adjustment contributed to optimizing therapeutic target attainment and enhancing treatment safety. Further research is needed to individualize initial dosing strategies to improve early achievement of target AUC.