Pharmacokinetics of Vancomycin and Dosing Regimen in Critically Ill Patients With Sepsis or Septic Shock: A Narrative Review

Background: Vancomycin is a drug of choice in Methicillin-resistant Staphylococcus aureus (MRSA) infection. The AUC24/MIC of 400-600 μg·h/mL is recommended to achieve therapeutic outcome and prevent nephrotoxicity. In critically ill patients with sepsis/septic shock, various physiological changes may impact vancomycin pharmacokinetics, such as volume of distribution and clearance, suggesting the importance of therapeutic drug monitoring (TDM). This article reviews vancomycin pharmacokinetic changes and dosing regimens that may be useful in determining vancomycin regimens for critically ill patients with sepsis, especially in the absence of therapeutic drug monitoring.Method: A literature search was conducted for relevant articles through databases, including PubMed and Google Scholar. Original articles published between 2016 and 2026 were screened for relevance. Articles reporting vancomycin pharmacokinetics and/or dosing recommendations were included in this review.Result: Based on the assessment of 9 collected articles, vancomycin showed varying pharmacokinetic changes that are affected by multiple factors, such as renal function, body weight, age, albumin levels, and hemoglobin levels. The use of a loading dose may be beneficial at the start of vancomycin treatment for appropriate patients. The maintenance dose should consider renal function and pathogen MIC, as it is associated with the risk of nephrotoxicity.Conclusion: Designing a proper dosing regimen for critically ill patients with sepsis requires careful consideration to achieve good therapeutic outcome and prevent nephrotoxicity. Therapeutic drug monitoring (TDM) should be conducted whenever possible.