Feasibility of vancomycin AUC24 monitoring using peak and trough concentrations in pediatric patients: a prospective multicenter study

Background Vancomycin remains a key medication in treating infections in pediatric patients, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). Conventional trough-based monitoring has shown limited accuracy in predicting therapeutic exposure and nephrotoxicity. Recent guidelines recommend area under the concentration–time curve (AUC)-based monitoring, but pediatric evidence remains scarce. Our objective is to assess the feasibility of vancomycin AUC 24 monitoring using peak–trough concentrations in routine pediatric clinical practice and examine its correlation with the trough levels. Methods We conducted a prospective, multicenter study in 70 pediatric inpatients receiving vancomycin at two tertiary hospitals in Riyadh, Saudi Arabia. Vancomycin AUC 24 was calculated using first-order pharmacokinetics from peak and trough levels. AUC 24 was compared with the trough concentrations and dosing regimens. Results Implementation of AUC 24 -based monitoring was feasible in routine pediatric workflow. Pharmacists successfully calculated AUC 24 using the Sanford Guide mobile app, with minimal training required for nurses on sampling. The correlation between the trough levels and AUC 24 was strong (ρ = 0.789, p 0.001), but the trough values did not consistently predict target attainment (AUC 24 400 μg h/mL–600 μg h/mL). At trough concentrations of 10 μg/mL–15 μg/mL, only approximately half of the patients achieved the target AUC 24 range (400 μg h/mL–600 μg h/mL), whereas at troughs of 15 μg/mL–20 μg/mL, nearly half of the patients exceeded the safe exposure thresholds, underscoring the limitations of trough-based monitoring. Conclusion AUC 24 estimation from peak and trough samples was feasible in routine pediatric workflow, providing more accurate exposure assessment than trough-guided monitoring. Implementation may improve efficacy and minimize nephrotoxicity.