Use of vancomycin pharmacokinetic–pharmacodynamic properties in the treatment of MRSA infections

Abstract

Vancomycin is a commonly used antimicrobial in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Increasing vancomycin MIC values in MRSA clinical isolates makes the optimization of vancomycin dosing pivotal to its continued use. Unfortunately, limited data exist regarding the optimal pharmacokinetic–pharmacodynamic (PK–PD) goal to improve bacterial killing and clinical outcomes with vancomycin. The hallmark study in this area suggests that achieving an AUC to MIC ratio of over 400 improves the likelihood of achieving these outcomes. Challenges in the implementation of PK–PD-based dosing for vancomycin include current methodologies utilized in microbiology laboratories, as well as intra- and interpatient pharmacokinetic variability. Individualized dosing based on MIC and specific patient factors is important to achieve optimal outcomes from vancomycin therapy.

Keywords::

• critically ill
• meningitis
• MIC
• MRSA
• obesity
• osteomyelitis
• pharmacodynamic
• pharmacokinetic
• pneumonia
• vancomycin

Financial & competing interests disclosure

Ronald Hall’s involvement in this publication was supported by Grant Number KL2RR024983, titled ‘North and Central Texas Clinical and Translational Science Initiative’ (Milton Packer) from the National Center for Research Resources (NCRR), a component of the NIH and NIH Roadmap for Medical Research, and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR or NIH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

This manuscript benefitted significantly from the critical review of Travis Cooper. No other writing assistance has been utilized in the production of this manuscript.