Vancomycin Pharmacodynamics: Optimal vs. Controversial

Abstract

After more than 55 years of use vancomycin still remains a viable agent primarily in the treatment of Staphylococcus aureus infections, but not without controversy. Issues of rising MICs (“MIC creep”), increased treatment failure, recommendations for more aggressive dosing, and an associated increased incidence of vancomycin-associated renal dysfunction have reinforced the importance of pharmacokinetic dosing services and antimicrobial stewardship initiatives to optimize safe and effective administration. This chapter addresses recent literature regarding optimal pharmacodynamic vancomycin administration to improve efficacy, minimize toxicity, adjust for specific patient populations, address caveats in the interpretation of MICs and creatinine clearance calculations, and compare various dosing methods. Although we are unlikely to see randomized controlled trials for many of these concerns, there remain unmet opportunities for new research.