Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review
Vancomycin is a hydrophilic antibiotic widely used in severe infections, including bacteremia and central nervous system (CNS) infections caused by Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci and enterococci. Appropriate antimic...
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| Format: | Article |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.835557/full |
| _version_ | 1828878382958379008 |
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| author | Qile Xiao Hainan Zhang Xiaomei Wu Jian Qu Lixia Qin Chunyu Wang |
| author_facet | Qile Xiao Hainan Zhang Xiaomei Wu Jian Qu Lixia Qin Chunyu Wang |
| author_sort | Qile Xiao |
| collection | DOAJ |
| description | Vancomycin is a hydrophilic antibiotic widely used in severe infections, including bacteremia and central nervous system (CNS) infections caused by Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci and enterococci. Appropriate antimicrobial dosage regimens can help achieve the target exposure and improve clinical outcomes. However, vancomycin exposure in serum and cerebrospinal fluid (CSF) is challenging to predict due to rapidly changing pathophysiological processes and patient-specific factors. Vancomycin concentrations may be decreased for peripheral infections due to augmented renal clearance (ARC) and increased distribution caused by systemic inflammatory response syndrome (SIRS), increased capillary permeability, and aggressive fluid resuscitation. Additionally, few studies on vancomycin’s pharmacokinetics (PK) in CSF for CNS infections. The relationship between exposure and clinical response is unclear, challenging for adequate antimicrobial therapy. Accurate prediction of vancomycin pharmacokinetics/pharmacodynamics (PK/PD) in patients with high interindividual variation is critical to increase the likelihood of achieving therapeutic targets. In this review, we describe the interaction between ARC and vancomycin PK/PD, patient-specific factors that influence the achievement of target exposure, and recent advances in optimizing vancomycin dosing schedules for severe infective patients with ARC. |
| first_indexed | 2024-12-13T09:04:08Z |
| format | Article |
| id | doaj.art-50c7a8173c9b4faab1100d1de49da98e |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-13T09:04:08Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-50c7a8173c9b4faab1100d1de49da98e2022-12-21T23:53:06ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-03-011310.3389/fphar.2022.835557835557Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative ReviewQile Xiao0Hainan Zhang1Xiaomei Wu2Jian Qu3Lixia Qin4Chunyu Wang5Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurology, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurology, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurology, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurology, Second Xiangya Hospital, Central South University, Changsha, ChinaVancomycin is a hydrophilic antibiotic widely used in severe infections, including bacteremia and central nervous system (CNS) infections caused by Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci and enterococci. Appropriate antimicrobial dosage regimens can help achieve the target exposure and improve clinical outcomes. However, vancomycin exposure in serum and cerebrospinal fluid (CSF) is challenging to predict due to rapidly changing pathophysiological processes and patient-specific factors. Vancomycin concentrations may be decreased for peripheral infections due to augmented renal clearance (ARC) and increased distribution caused by systemic inflammatory response syndrome (SIRS), increased capillary permeability, and aggressive fluid resuscitation. Additionally, few studies on vancomycin’s pharmacokinetics (PK) in CSF for CNS infections. The relationship between exposure and clinical response is unclear, challenging for adequate antimicrobial therapy. Accurate prediction of vancomycin pharmacokinetics/pharmacodynamics (PK/PD) in patients with high interindividual variation is critical to increase the likelihood of achieving therapeutic targets. In this review, we describe the interaction between ARC and vancomycin PK/PD, patient-specific factors that influence the achievement of target exposure, and recent advances in optimizing vancomycin dosing schedules for severe infective patients with ARC.https://www.frontiersin.org/articles/10.3389/fphar.2022.835557/fullvancomycincritically illinfectionaugmented renal clearancepharmacokinetics/pharmacodynamics |
| spellingShingle | Qile Xiao Hainan Zhang Xiaomei Wu Jian Qu Lixia Qin Chunyu Wang Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review Frontiers in Pharmacology vancomycin critically ill infection augmented renal clearance pharmacokinetics/pharmacodynamics |
| title | Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review |
| title_full | Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review |
| title_fullStr | Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review |
| title_full_unstemmed | Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review |
| title_short | Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review |
| title_sort | augmented renal clearance in severe infections an important consideration in vancomycin dosing a narrative review |
| topic | vancomycin critically ill infection augmented renal clearance pharmacokinetics/pharmacodynamics |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.835557/full |
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