Akademik Veri Yönetim Sistemi
Developments and Experiments in Health and Medicine, cilt.40, sa.2, ss.145-157, 2026 (Hakemli Dergi)
ABSTRACT Vancomycin is a cornerstone agent in the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and other penicillin-resistant gram-positive bacteria. However, due to its narrow therapeutic window, substantial interindividual pharmacokinetic variability, and risk of nephrotoxicity, therapeutic drug monitoring (TDM) is recommended to optimize its efficacy and safety. Current guidelines recommend shifting from trough concentration-based monitoring to evaluation of the ratio of the 24-hour area under the concentration-time curve to the minimum inhibitory concentration (AUC24/MIC), particularly in the management of severe MRSA infections. However, because many centers lack the infrastructure required for routine AUC-based monitoring, trough-based TDM remains widely used and clinically relevant. In this narrative review, we synthesize current guideline recommendations and established reference sources on infectious diseases and clinical pharmacology to provide a comprehensive overview of the scientific principles, practical methods, target pharmacokinetic/pharmacodynamic (PK/PD) thresholds, and real-world challenges associated with vancomycin TDM in adult patients. This review aims to support the standardization of TDM practices and contribute to improving the safety and effectiveness of vancomycin use in clinical settings across Türkiye. A structured literature search of PubMed was conducted to identify relevant studies published between March 2020 and November 2025, including international guidelines, prospective or randomized controlled clinical trials, and outcome-based studies evaluating vancomycin exposure targets. Accumulating evidence suggests that PK/PD targets derived primarily from MRSA infections may not be universally applicable to other gram-positive pathogens. Future prospective randomized studies are needed to better define optimal exposure targets across diverse infections. In addition, the development of nationally standardized TDM guidelines and multidisciplinary implementation strategies may improve treatment outcomes, enhance the consistency of dosing decisions, and reduce errors related to sampling timing, interpretation of drug concentrations, and vancomycin exposure assessment. Such approaches may ultimately promote safer, more rational vancomycin use and improve the reliability of TDM practices in routine clinical care, particularly in developing healthcare settings such as Türkiye.