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Vancomycin therapeutics and monitoring: a contemporary approach
Author(s) -
Avent M. L.,
Vaska V. L.,
Rogers B. A.,
Cheng A. C.,
van Hal S. J.,
Holmes N. E.,
Howden B. P.,
Paterson D. L.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12036
Subject(s) - medicine , vancomycin , therapeutic drug monitoring , pharmacokinetics , intensive care medicine , population , drug , empiric therapy , pharmacology , pathology , alternative medicine , environmental health , biology , bacteria , genetics , staphylococcus aureus
Vancomycin remains a clinically useful antibiotic despite the advent of several alternative drugs. Optimising vancomycin therapy with therapeutic drug monitoring is widely recommended. The aim of therapeutic drug monitoring is to help the clinician to achieve target pharmacodynamic parameters in the case of vancomycin, an area under the concentration time curve/minimum inhibitory concentration ratio of ≥400. Vancomycin monitoring methods can be categorised into four categories: empiric trough concentrations; linear regression analysis (one‐compartment model), population methods and B ayesian estimation procedures. Although the empiric trough concentrations and population methods are easy to use and require minimal resources, there are large differences in the published vancomycin model parameters. This demonstrates that there is great variance in pharmacokinetic parameters between the models and a single vancomycin model cannot be applied to all patient populations. The linear regression and B ayesian methods recommended more accurate dosage regimens; however, they require additional resources such as information technology and healthcare personnel with background training in pharmacokinetics. The B ayesian methods offered additional advantages such as calculation of doses based on a single‐serum concentration and optimisation of the patient's previous pharmacokinetic data to determine subsequent dosage regimens. Computerised programs, utilising the B ayesian estimation procedures, are able to achieve target concentrations in a greater percentage of patients earlier in the course of therapy than the empiric trough concentrations and population methods. We recommend the use of these programs providing there is appropriate expertise available to make appropriate recommendations.