Vancomycin Therapy Monitoring-The Gaps Between Guidelines and Clinical Practice.

BACKGROUND

Therapeutic drug monitoring represents an improvement in treatment efficacy and helps reduce side effects. For vancomycin therapy, plasma analysis helps prevent subtherapeutic dosages, which can lead to treatment failure and the potential emergence of antibiotic resistance, while also limiting side effects caused by toxicity.

AREAS OF UNCERTAINTY: Although vancomycin dosing based on area under the curve (AUC) has been supported by scientific grade IIIA evidence as improving patient outcomes, it is still not widely adopted, and many questions remain unanswered. There is significant heterogeneity in therapeutic range values presented in guidelines for both point-to-point and AUC measurements, and uncertainty about when to apply these protocols in vancomycin administration. This narrative review aims to evaluate the indications and target values presented in current vancomycin monitoring guidelines, comparing them with studies where vancomycin dosing is not recommended.

DATA SOURCES: Articles related to vancomycin dosing were searched on medical databases such as Scopus, PubMed, and Google Scholar.

THERAPEUTIC ADVANCES: All review articles and guidelines issued by scientific societies support vancomycin dosing, particularly for dialysis patients, pediatric patients, and those in intensive care units. Although target values may vary across guidelines, trough values between 10 and 20 mg/L are widely accepted. Although AUC-based dosing is more complex, it is recommended, with a therapeutic range between 400 and 700 mg/L/24 h. Although some authors challenge this approach, they reflect the opinions of a relatively small group of experts.

CONCLUSIONS

Further pharmacokinetic studies are required to furnish robust evidence and facilitate the establishment of a uniform recommendation for vancomycin drug monitoring by guidelines. In addition, it is essential to assess vancomycin dosing across all patient categories to examine the viability of theories that do not support the need for vancomycin dosing.