Inventi Rapid: Pharmacy Practice

Inventi:prpp/114735/26

Vancomycin Associated Nephrotoxicity: Mechanisms, Risk Factors and Clinical Management

Vancomycin is a cornerstone antibiotic for serious infections caused by methicillin resistant Staphylococcus aureus. However, its clinical utility is limited by vancomycin associated nephrotoxicity (VAN), a significant adverse effect associated with increased morbidity and healthcare burden. This narrative review provides a comprehensive overview of the incidence, pathophysiological mechanisms, risk factors, outcomes and current strategies for prevention, monitoring and management of VAN. A structured literature review was conducted focusing on clinical and experimental studies evaluating VAN, including pharmacokinetic/pharmacodynamic considerations and recent guidelines updates. Vancomycin associated nephrotoxicity is a multifactorial condition involving oxidative stress, inflammatory pathways, tubular injury and cast formation. Its incidence varies widely (5-43%) depending on patient characteristics and treatment related factors. Key risk factors include high vancomycin exposure, prolonged therapy, critical illness and concomitant use of nephrotoxic agents. Emerging evidence supports AUC-guided dosing as a safer and more effective strategy compared to traditional trough-based monitoring. Preventive approaches focus on dose optimization, early therapeutic drug monitoring and minimization of concurrent nephrotoxins. In conclusion VAN remains a clinically significant challenge which requires optimizing vancomycin exposure through AUC-guided monitoring and individualized dosing strategies to balance efficacy and safety....