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Pharmacol Res Perspect. 2018 Jul;6(4):e00420. doi: 10.1002/prp2.420.

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations.

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Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.
Instituto de Investigação e Formação Avançadas em Ciências e Tecnologias da Saúde (IINFACTS), Instituto Universitário de Ciências da Saúde (IUCS), Gandra, Portugal.
Instituto de Ciências Biológicas, Curso de Farmácia, Universidade de Passo Fundo (UPF), Passo Fundo, Brasil.
Laboratório de Farmacologia, Departamento de Ciências do Medicamento, Faculdade de Farmácia da Universidade do Porto (FFUP), Porto, Portugal.
I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.


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.


pharmacokinetics; special subpopulations; therapeutic drug monitoring; vancomycin

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