Abstract:
Introduction: Vancomycin is a glycopeptide antibiotic that is
considered as the drug of choice against many Gram-positive bacterial
infections, especially Methicillin-resistant Staphylococcus
aureus (MRSA). Also, it is a hydrophilic drug with predominantly renal
elimination. Given the vancomycin narrow therapeutic index, therapeutic
drug monitoring (TDM) is essential to achieve an optimum clinical
response and avoid vancomycin-induced adverse drug reactions including
nephrotoxicity and ototoxicity. Although different studies are available
on vancomycin pharmacokinetic assessment and vancomycin TDM, still there
are controversies regarding the selection among different
pharmacokinetic parameters including trough concentration
(Cmin), the daily area under the curve to minimum
inhibitory concentration (AUC24h/MIC) ratio, AUC of
intervals (AUCĪ), elimination constant (k), vancomycin clearance
(ClV) and methods of their calculations for TDM
purposes.
Methods: In this review, different pharmacokinetic parameters
for vancomycin TDM have been discussed in detail along with
corresponding advantages and disadvantages, based on the literature
review. Determination of vancomycin concentration at steady state
(Css) during 24h continuous injection are mentioned.
Also, vancomycin pharmacokinetic assessments are discussed in detail in
patients with altered pharmacokinetic parameters including those with
renal and/or hepatic failure, critically ill patients, patients with
burn injuries, intravenous (IV) drug users, obese and morbidly obese
patients, those with cancer, patients undergoing organ transplantation,
and vancomycin administration during pregnancy and lactation.
Results and Discussion: An individualized dosing regimen is
required to guarantee the optimum therapeutic results and minimize
severe adverse reaction such as acute kidney injury (AKI) in these
special groups of patients with altered pharmacokinetic parameters.
Also, according to the pharmacoeconomic data on vancomycin TDM,
pharmacokinetic assessments would be cost-effective in the mentioned
groups of patients with altered pharmacokinetics and associated with
shorter hospitalization period, faster clinical stability status, and
shorter courses of inpatient vancomycin administration.
Keywords: Vancomycin; therapeutic drug monitoring (TDM);
altered pharmacokinetics; acute kidney injury (AKI); individualized
pharmacotherapy.