Affiliation:
1. Pharmaceutical Sciences Research Center, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
2. Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
3. Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Abstract:
Vancomycin is considered the drug of choice against many Gram-positive bacterial infections.
Therapeutic drug monitoring (TDM) is essential to achieve an optimum clinical response
and avoid vancomycin-induced adverse reactions including nephrotoxicity. Although different
studies are available on vancomycin TDM, still there are controversies regarding the selection
among different pharmacokinetic parameters including trough concentration, the area under the
curve to minimum inhibitory concentration ratio (AUC24h/MIC), AUC of intervals, elimination
constant, and vancomycin clearance. In this review, different pharmacokinetic parameters for vancomycin
TDM have been discussed along with corresponding advantages and disadvantages. Also,
vancomycin pharmacokinetic assessments are discussed in patients with altered pharmacokinetic
parameters including those with renal and/or hepatic failure, critically ill patients, patients with
burn injuries, intravenous drug users, obese and morbidly obese patients, those with cancer, patients
undergoing organ transplantation, and vancomycin administration during pregnancy and lactation.
An individualized dosing regimen is required to guarantee the optimum therapeutic responses
and minimize adverse reactions including acute kidney injury in these special groups of
patients. According to the pharmacoeconomic data on vancomycin TDM, pharmacokinetic assessments
would be cost-effective in patients with altered pharmacokinetics and are associated with
shorter hospitalization period, faster clinical stability status, and shorter courses of inpatient vancomycin
administration.
Publisher
Bentham Science Publishers Ltd.
Subject
Pharmacology (medical),Pharmacology,Toxicology