%0 Journal Article
%T Augmented Renal Clearance and Its Influence on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients
%A Yujie Yi
%A Xiaotong Li
%A Hu Liu
%A Haitao Xie
%J Bulletin of Pioneering Researches of Medical and Clinical Science
%@ 3006-2659
%D 2024
%V 4
%N 2
%R 10.51847/yL5jEKKhNn
%P 78-87
%X Augmented renal clearance (ARC), defined as a creatinine clearance (CrCl) greater than 130 mL/min/1.73 m², is increasingly recognized among critically ill patients, affecting roughly one-third to two-thirds of this population. Standard vancomycin dosing regimens are often inadequate for these individuals, as enhanced renal filtration accelerates drug elimination and leads to subtherapeutic serum concentrations, compromising antimicrobial efficacy. The present review examines how ARC influences vancomycin’s pharmacokinetic and pharmacodynamic (PK/PD) parameters and explores approaches for optimizing dosing in affected patients. A systematic search of the MEDLINE and EMBASE databases was performed in September 2023 to identify studies evaluating vancomycin use in critically ill adults with ARC. Reports focused on pediatric patients or lacking detailed PK data were excluded. Twenty-one studies met the selection criteria. The collective findings revealed a strong association between elevated CrCl and increased vancomycin clearance, supporting the need for higher or individualized dosing strategies to reach therapeutic exposure. Younger age emerged as a consistent predictor of ARC and altered vancomycin disposition. This review summarizes key PK/PD alterations, assesses available dosing guidelines, and proposes evidence-based adjustments aimed at improving target attainment and reducing the likelihood of treatment failure in patients with ARC.
%U https://bprmcs.com/article/augmented-renal-clearance-and-its-influence-on-vancomycin-pharmacokinetics-and-pharmacodynamics-in-c-czohrpfcm8hqvyq