Clinical pharmacokinetics of vancomycin

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Increasing use of vancomycin for methicillin-resistant staphylococci infections.
• Focus on vancomycin's pharmacokinetics and its relation to efficacy and toxicity.
• Case reports of oral vancomycin achieving therapeutic serum concentrations.

Purpose of the Study:

• To characterize vancomycin disposition in patients.
• To assess the relationship between serum concentrations and clinical outcomes.
• To review available data on vancomycin distribution in various body fluids and tissues.

Main Methods:

• Review of recent studies on vancomycin pharmacokinetics.
• Analysis of triexponential model for parenteral vancomycin disposition.
• Examination of data on vancomycin excretion and distribution in biological fluids.

Main Results:

• Parenteral vancomycin follows a triexponential disposition model with a terminal half-life of 3-9 hours in normal renal function.
• Renal clearance approximates 0.5-0.8 of creatinine clearance, indicating glomerular filtration as the primary route.
• Variable vancomycin penetration into cerebrospinal fluid; therapeutic concentrations achieved in other body fluids like ascites and pleural fluid.

Conclusions:

• Vancomycin disposition is complex, influenced by renal function.
• Further research is needed to define vancomycin pharmacokinetics in hepatic disease.
• Understanding vancomycin distribution is crucial for optimizing treatment of resistant infections.