{"id":4746,"date":"2020-01-10T04:44:57","date_gmt":"2020-01-09T18:44:57","guid":{"rendered":"https:\/\/doseme-rx.com\/?p=4746"},"modified":"2021-04-13T16:49:51","modified_gmt":"2021-04-13T06:49:51","slug":"how-to-prepate-for-new-guidelines","status":"publish","type":"post","link":"https:\/\/doseme-rx.com\/en-gb\/vancomycin\/articles\/how-to-prepate-for-new-guidelines","title":{"rendered":"Preparing for the New Vancomycin Guidelines \u2013 What Should You Be Considering?"},"content":{"rendered":"\n<p><strong>Note: The new&nbsp;<a href=\"https:\/\/doseme-rx.com\/news\/20200401-vancomycin-dosing-guidelines-2020-clinical-summary\">vancomycin dosing guidelines<\/a>&nbsp;have been officially released. Learn what&#8217;s changed and how they&#8217;ll impact you by reading our guide to the&nbsp;<a href=\"https:\/\/doseme-rx.com\/news\/20200330-vancomycin-dosing-guidelines-what-to-know\">new vancomycin dosing changes&nbsp;here<\/a>.<\/strong><\/p>\n\n\n\n<p>The long-awaited <a href=\"https:\/\/doseme-rx.com\/news\/20190601-vancomycin-dosing-therapeutic-guideline-2019\">updated guidelines for vancomycin dosing and monitoring<\/a> are forthcoming. You may be considering how to prepare for this significant change from trough-based monitoring of vancomycin to AUC-based dosing strategies. DoseMe has supported hundreds of customers with the transition and have been able to provide insights into overcoming the challenges this change management process may bring.&nbsp;<\/p>\n\n\n\n<p>Now is the time for pharmacists and healthcare providers to prepare for the guideline changes. Topics to consider include:&nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"#whats-changing\">The proposed new vancomycin guidelines: what\u2019s changing?<\/a><\/li><li><a href=\"#benefit-of-bayesian-dosing\">The benefit of Bayesian dosing for vancomycin optimization \u2014features and benefits<\/a><\/li><li><a href=\"#how-to-prepare\">What should we be doing now to prepare for AUC-based dosing?&nbsp;<\/a><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"740\" height=\"380\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/11\/Vanco-guideline-09v19.png\" alt=\"New vancomycin guidelines - what's new?\" class=\"wp-image-4522\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/11\/Vanco-guideline-09v19.png 740w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/11\/Vanco-guideline-09v19-300x154.png 300w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"whats-changing\">The New Vancomycin Dosing Guidelines: What\u2019s Changing?&nbsp;<\/h2>\n\n\n\n<p>These guidelines replace the previous version published a decade ago.<sup>1 <\/sup>Intravenous vancomycin is one of the most commonly used antibiotics in healthcare. Although vancomycin has been in use for over 60 years, new information is continually emerging on how to maximize the efficacy of the drug while minimizing toxicity.&nbsp;<\/p>\n\n\n\n<p>While it was once standard to monitor both a peak and a trough serum concentration, in the 2009 guidelines, a peak was no longer recommended. The available evidence at the time of the 2009 guidelines indicated monitoring peaks did not reduce vancomycin-induced nephrotoxicity.&nbsp;&nbsp;<\/p>\n\n\n\n<p>The 2009 vancomycin therapeutic guidelines introduced the concept of dosing based on <a href=\"https:\/\/www.thebody.com\/article\/ab-cs-pharmacokinetics\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Area Under the Curve (AUC)<\/a> and established the relationship between the AUC and the minimum inhibitory concentration (MIC) or <a href=\"https:\/\/www.thebody.com\/article\/ab-cs-pharmacokinetics\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">AUC:MIC<\/a> as a \u201cuseful pharmacodynamic parameter to predict effectiveness.\u201d However, due to the burden of obtaining multiple serum vancomycin levels along with the challenges of performing AUC mathematical calculations, the guideline authors recommended using a vancomycin trough level for use as a possible surrogate.<\/p>\n\n\n\n<p>Since those 2009 guidelines were published, more research has emerged. Thus healthcare is migrating away from trough-based dosing and towards AUC based dosing.&nbsp;<\/p>\n\n\n\n<div class=\"wp-block-group alignfull\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull has-background-dim has-background-gradient has-purple-gradient-background landing-cover--graph-underlay\" style=\"min-height:430px;aspect-ratio:unset;\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h2 class=\"has-text-align-center has-white-color has-text-color wp-block-heading\">Vancomycin AUC Conversion Toolkit<\/h2>\n\n\n\n<p class=\"has-text-align-center\">Get instant access to our concise range of free checklists, tips and templates to support you in successfully transitioning to an AUC-based dosing strategy.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-white-color has-text-color\" href=\"https:\/\/doseme-rx.com\/vancomycin-auc-conversion-toolkit\">EXPLORE NOW<\/a><\/div>\n<\/div>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div><\/div>\n\n\n\n<p>This will create a huge paradigm shift in how vancomycin therapy will be monitored moving forward, especially for the treatment of methicillin resistant <em>Staphylococcus aureus (MRSA).<\/em> The upcoming guidelines, which are currently in draft form<sup>2<\/sup> are firmly recommending AUC:MIC as the optimal pharmacodynamic target.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"740\" height=\"380\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Blog-Image.jpg\" alt=\"\" class=\"wp-image-4778\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Blog-Image.jpg 740w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Blog-Image-300x154.jpg 300w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"benefit-of-bayesian-dosing\">The Benefit of Bayesian Dosing for Vancomycin Optimization&nbsp;<\/h3>\n\n\n\n<p><a href=\"https:\/\/doseme-rx.com\/science-behind-doseme\">Bayesian dosing<\/a> uses patient data and laboratory results, when available, in conjunction with a published population model, to recommend an individualized dose of vancomycin for that patient. The proposed vancomycin therapeutic guidelines recommend population pharmacokinetic modelling with the use of Bayesian software \u2013 what many are now referring to as the gold standard of clinical decision support for vancomycin dosing and monitoring.<\/p>\n\n\n\n<p>In their discussion of the numerous benefits of Bayesian dosing, often referred to as \u2018precision dosing,\u2019 the authors identify a few advantages to the modelling approach, such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Reduces reliance on timing of timing of drug levels<\/li><li>Less drug levels required to accurately estimate AUC<\/li><li>Drug levels can be taken before steady state<\/li><li>Bayesian models are dynamic \u2013 the individualized PK\/PD model is continuously learning over time<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"740\" height=\"380\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/01\/Doctors-Hallway-Image-740x380.jpg\" alt=\"\" class=\"wp-image-3557\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/01\/Doctors-Hallway-Image-740x380.jpg 740w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2019\/01\/Doctors-Hallway-Image-740x380-300x154.jpg 300w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"how-to-prepare\">What Should We Be Doing Now to Prepare?<\/h2>\n\n\n\n<p>It is important to begin discussing these upcoming guideline changes with your teams, including nursing, pharmacy, and the medical staff.&nbsp;<\/p>\n\n\n\n<p>Key topics to address include:&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Basic definitions<\/h3>\n\n\n\n<p>Many of our partners found it helpful to review the basics of pharmacokinetics and pharmacodynamics with their teams, such as half-life, volume of distribution, and AUC. DoseMe provides a vancomycin  <a href=\"https:\/\/doseme-rx.com\/news\/20190601-vancomycin-dosing-therapeutic-guideline-2019\">pharmacokinetics refresher<\/a> that is a helpful resource for pharmacy staff and clinicians.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical rationale<\/h3>\n\n\n\n<p>The new proposed guidelines recommend a Bayesian-derived AUC\/MIC<sub>BMD<\/sub>* ratio of 400 to 600 (assuming a vancomycin MIC<sub>BMD90<\/sub> of 1 mg\/L). Prescribers may not be fully aware of the literature highlighting the<strong> <\/strong><a href=\"https:\/\/doseme-rx.com\/news\/20181019-auc-dosing\">therapeutic benefit<\/a> of shifting away from dosing based on a trough level and towards calculation of an AUC to help guide dosing decisions.&nbsp;  <\/p>\n\n\n\n<p>*BMD = Broth microdilution <\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Education<\/h3>\n\n\n\n<p>DoseMe customers have recognized that interdisciplinary education about AUC-guided dosing is needed and is a critical component of a successful transition. Assistant Professor Luigi Brunetti, PharmD, MPH Clinical Pharmacist at Robert Wood Johnson University Hospital Somerset, discusses strategies for incorporating AUC-based dosing approaches into clinical workflow in this CE accredited course: <a href=\"https:\/\/doseme-rx.com\/bayesian-dosing-continuing-education\">Optimizing Vancomycin Therapy: Transitioning from trough based to AUC\/MIC based dosing.<\/a>&nbsp;<\/p>\n\n\n\n<p>Dr. Brunetti advocates for engaging the appropriate partners in the conversation including not only pharmacy, but also physicians (including infectious diseases), laboratory staff, and nursing. Soliciting input from each group will help to identify the topics that need additional education and will help pharmacy to customize training and education ducation towards for each of these audiences. In addition, it is important to start to have conversations with these groups to understand the upcoming changes to your pharmacy workflow in order to adjust to dosing and monitoring based on AUC.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Improved safety benefit<\/h3>\n\n\n\n<p>Multiple clinical studies have shown that AUC-based vancomycin therapy can reduce the occurrence of vancomycin associated acute kidney injury (AKI). Vancomycin-associated AKI is commonly defined as 1) an increase in&nbsp;serum creatinine of&nbsp; \u2265 0.5 mg\/dL or 2) a 50% increase from baseline in consecutive daily readings, or 3) a decrease in calculated&nbsp;creatinine clearance&nbsp;of 50% from baseline on two consecutive days in the absence of an alternative explanation. Newer studies suggest that a more sensitive threshold of an increase in&nbsp;serum creatinine \u2265 0.3 mg\/dL over a 48-hour period may be an indicator of AKI.<\/p>\n\n\n\n<p>There are multiple publications that provide an excellent review of vancomycin associated AKI. These include:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"http:\/\/www.ajhp.org\/content\/early\/2018\/10\/16\/ajhp180034?sso-checked=true\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Making the change to area under the curve-based vancomycin dosing<\/a>&nbsp;(Heil et al., 2018)<\/li><li><a href=\"https:\/\/cjasn.asnjournals.org\/content\/11\/12\/2132.long\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Vancomycin and the risk of AKI: a systematic review and meta-analysis<\/a> (Sinha Ray et al., 2016)<\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3553731\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter<\/a> (van Hal, Paterson and Lodise, 2012)<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">AUC-based Monitoring of Vancomycin Literature Review<\/h3>\n\n\n\n<p>We have compiled a list of independent research related to AUC-based monitoring of vancomycin shown to enhance patient outcomes, reduce adverse drug events, and lower healthcare costs. This  research  also highlights some of the challenges associated with the implementation of an AUC-based approach and evidence supporting the relationship between AUC:MIC and clinical outcomes &#8211; <a href=\"https:\/\/doseme-rx.com\/vancomycin-literature-review\">read now<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Next steps: Reviewing Bayesian Dosing&nbsp;<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Reviewing Bayesian dosing and understanding how a Bayesian dosing software, such as DoseMeRx, can support your vancomycin monitoring program. There is a preference given in the guidelines towards monitoring AUC using Bayesian software. By using a program that is supported by richly sampled vancomycin data (referred to as Bayesian prior), the pharmacist or other individual responsible for monitoring vancomycin can utilize the Bayesian dosing software to calculate doses designed to achieve the targeted AUC range.<\/li><li>Depending on your hospital\u2019s patient population, another advantage of considering a Bayesian program is that it can accommodate multiple <a href=\"https:\/\/doseme-rx.com\/vancomycin-dosing\">vancomycin models<\/a>. This can assist you across adult, pediatric and neonate patients, including obese and hemodialysis sub populations.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Levels: decreased reliance of timing and counts<\/h3>\n\n\n\n<p>Although obtaining two levels (e.g. a trough and then a peak 1-2 hours after the end of the infusion) is optional, Bayesian dosing allows the use of a single level \u2013 thus, no nursing or phlebotomy workflow changes are required. Bayesian dosing tools like DoseMeRx can make <a href=\"https:\/\/help.doseme-rx.com\/en\/articles\/2351715-how-important-is-the-time-i-take-a-patient-s-blood-test\">mathematical accommodations<\/a> if the level is not drawn at an exact time, preventing a wasted blood draw.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Meet with me: Dr Kristi Kuper, Director of Clinical Pharmacy, DoseMe&nbsp;<\/h3>\n\n\n\n<p>If you would like to learn more about how we can support your transition to AUC-based vancomycin dosing, please email me at <a href=\"mailto:kkuper@dosemehealth.com\">kkuper@dosemehealth.com<\/a> or call (832) 358 3308.<\/p>\n\n\n\n<p>I would be happy to share more insights into how we have supported other institutions through this change management process.<\/p>\n\n\n    <div class=\"author-block\">\r\n        <h2>About the author:<\/h2>\r\n        <div class=\"author-block_inner\">\r\n            <img decoding=\"async\" width=\"360\" height=\"300\" src=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Untitled-design-12.png\" class=\"attachment-small size-small\" alt=\"\" srcset=\"https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Untitled-design-12.png 360w, https:\/\/doseme-rx.com\/wp-content\/uploads\/2020\/01\/Untitled-design-12-300x250.png 300w\" sizes=\"(max-width: 360px) 100vw, 360px\" \/>            <div class=\"author_inner\" itemprop=\"author\" itemscope itemtype=\"http:\/\/schema.org\/Person\">\r\n                <span class=\"author_name\" itemprop=\"name\">Dr Kristi Kuper, Pharm.D., BCPS<\/span>\r\n                <span class=\"author_position\"><\/span>\r\n                            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n\n\n\n<h2 class=\"wp-block-heading\"> References  <\/h2>\n\n\n\n<ol class=\"wp-block-list\"><li>American Journal of Health System Pharmacists. \u201cTherapeutic Monitoring of Vancomycin in Adult Patients:&nbsp;<a href=\"https:\/\/www.ashp.org\/-\/media\/assets\/policy-guidelines\/docs\/therapeutic-position-statements\/therapeutic-monitoring-vancomycin-adults.ashx?la=en&amp;hash=CB26F91854B386F99E04D1DAF340019794AD860C\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">\u201cA Consensus Review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists.\u201d<\/a>&nbsp;Published 2009.&nbsp;&nbsp;<\/li><li>Rybak, MJ. Le J Lodise LP; et al.<a href=\"https:\/\/www.ashp.org\/-\/media\/assets\/policy-guidelines\/docs\/draft-guidelines\/draft-guidelines-ASHP-IDSA-PIDS-SIDP-therapeutic-vancomycin.ashx?la=en&amp;hash=8126CEE49F401CDEE5DB49712225F0A4518DB94B&amp;fbclid=IwAR0tgq_SfaBvgdRLOeb-y1umK2P2ROLwnJ-RMzSoY5iFSTVn-FeAhfSonoA\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">&nbsp;\u201cTherapeutic Monitoring of Vancomycin: A Revised Consensus Guideline.\u201d<\/a> Published 2019 (in press)&nbsp;<\/li><\/ol>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Related Articles<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/doseme-rx.com\/news\/20191213-auc24-vancomycin-dosing\">AUC24 Vancomycin Bayesian-based dosing: Increasing Therapeutic Target Attainment with Decreased Monitoring Costs<\/a><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/doseme-rx.com\/news\/20191119-vancomycin-trough-level-recommendations\">Vancomycin trough levels: Upcoming 2019 therapeutic drug monitoring recommendations<\/a><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/doseme-rx.com\/news\/20190809-vancomycin-from-tough-auc-webinar\">Webinar: Vancomycin From Trough to AUC: RWJ Barnabas Health Experience<\/a><\/li><\/ul>\n\n\n<div class=\"trial-form-module form_row\" id=\"bookademo\">\r\n    \r\n<div class=\"copy\">\r\n\t<h2 class=\"has-gold-color has-text-color\"><\/h2>\r\n\t<\/div>\t\t\r\n\r\n<script>\r\n\t$(function () {\r\n\t\t\r\n\t\t\r\n\t$.getJSON(\"https:\/\/api.ipstack.com\/check?access_key=2096fae20ea80a0c432c80c876bb462d&output=json\").done(function(e) {\r\n\t\t$(\"#input_11_7\").val(e.ip);\t\t\t\t\r\n\t\t$(\"#input_11_8\").val(e.city + \", \" + e.region_name + \", \" + 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><label class='gfield_label gform-field-label' for='input_11_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_11_5' type='email' value='' class='large'   placeholder='Email *' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_11_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_1'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_11_1' type='text' value='' class='large'    placeholder='First Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_9'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_11_9' type='text' value='' class='large'    placeholder='Last Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_2'>Hospital<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_11_2' type='text' value='' class='large'    placeholder='Hospital *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_13\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_13'>Number of Sites<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_11_13' type='number' step='any'   value='' class='large'    placeholder='Number of Sites *' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_11_17\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_17'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_11_17' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_11_6\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_6'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_11_6' type='tel' value='' class='large'  placeholder='Phone *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_14\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_14'>Questions or comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_11_14' class='textarea large'    placeholder='Questions or comments'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_7\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_7' id='input_11_7' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='216.73.216.91' \/><\/div><\/div><div id=\"field_11_8\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_8' id='input_11_8' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_11_10\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_10' id='input_11_10' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_11_15\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_15' id='input_11_15' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input 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Learn what&#8217;s changed and how they&#8217;ll impact you by reading our guide to the&nbsp;new vancomycin dosing changes&nbsp;here. The long-awaited updated guidelines for vancomycin dosing and monitoring are forthcoming. You may be considering how to prepare for this significant change from trough-based monitoring of vancomycin to AUC-based dosing [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":7632,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[26],"tags":[28,27,37],"article-type":[49],"class_list":["post-4746","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vancomycin","tag-auc","tag-trough","tag-vancomycin-dosing"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Preparing for the New Vancomycin Guidelines - DoseMe<\/title>\n<meta name=\"description\" content=\"The long-awaited updated vancomycin dosing and monitoring guidelines are forthcoming. Dr Kristi Kuper discusses recommendations to support this change.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/doseme-rx.com\/en-gb\/vancomycin\/articles\/how-to-prepate-for-new-guidelines\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Preparing for the New Vancomycin Guidelines - DoseMe\" \/>\n<meta property=\"og:description\" content=\"The long-awaited updated vancomycin dosing and monitoring guidelines are forthcoming. 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