Vancomycin therapeutics and monitoring: a contemporary approach

Avent, M. L., Vaska, V. L., Rogers, B. A., Cheng, A. C., Van Hal, S. J., Holmes, N. E., Howden, B. P. and Paterson, D. L. (2013) Vancomycin therapeutics and monitoring: a contemporary approach. Internal Medicine Journal, 43 2: 110-119. doi:10.1111/imj.12036

Author 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.
Title Vancomycin therapeutics and monitoring: a contemporary approach
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
Publication date 2013-02
Year available 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/imj.12036
Open Access Status
Volume 43
Issue 2
Start page 110
End page 119
Total pages 10
Place of publication Richmond, Vic., Australia
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Abstract 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 Bayesian 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 Bayesian methods recommended more accurate dosage regimens; however, they require additional resources such as information technology and healthcare personnel with background training in pharmacokinetics. The Bayesian 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 Bayesian 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.
Keyword Pharmacokinetics
Clinical pharmacology
Drug monitoring
Computerized models
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
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School of Medicine Publications
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Created: Mon, 11 Feb 2013, 13:42:14 EST by Mrs Maureen Pollard on behalf of Paediatrics & Child Health - RBWH