Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations.
Monteiro Joaquim FariaSiomara R HahnJorge GonçalvesPaula FrescoPublished in: Pharmacology research & perspectives (2018)
Vancomycin is a fundamental antibiotic in the management of severe Gram-positive infections. Inappropriate vancomycin dosing is associated with therapeutic failure, bacterial resistance and toxicity. Therapeutic drug monitoring (TDM) is acknowledged as an important part of the vancomycin therapy management, at least in specific patient subpopulations, but implementation in clinical practice has been difficult because there are no consensus and agglutinator documents. The aims of the present work are to present an overview of the current knowledge on vancomycin TDM and population pharmacokinetic (PPK) models relevant to specific patient subpopulations. Based on three published international guidelines (American, Japanese and Chinese) on vancomycin TDM and a bibliographic review on available PPK models for vancomycin in distinct subpopulations, an analysis of evidence was carried out and the current knowledge on this topic was summarized. The results of this work can be useful to redirect research efforts to address the detected knowledge gaps. Currently, TDM of vancomycin presents a moderate level of evidence and practical recommendations with great robustness in neonates, pediatric and patients with renal impairment. However, it is important to investigate in other subpopulations known to present altered vancomycin pharmacokinetics (eg neurosurgical, oncological and cystic fibrosis patients), where evidence is still unsufficient.
Keyphrases
- methicillin resistant staphylococcus aureus
- clinical practice
- healthcare
- cystic fibrosis
- staphylococcus aureus
- case report
- end stage renal disease
- chronic kidney disease
- ejection fraction
- prostate cancer
- newly diagnosed
- stem cells
- pseudomonas aeruginosa
- primary care
- randomized controlled trial
- oxidative stress
- early onset
- high intensity
- preterm infants
- bone marrow
- mesenchymal stem cells
- cell therapy
- smoking cessation
- patient reported outcomes
- childhood cancer