Vancomycin: How might Urinary Biomarkers and Precision Dosing create Precision Medicine for the most frequently utilized antibiotic in the hospital?

In the United States, vancomycin is the single most commonly prescribed antibiotic in the hospital setting and is a well-known nephrotoxin. Despite over 60 years of clinical use, there is still debate on the drivers, modifiers, and time-course of the kidney injury associated with vancomycin. Drug-induced kidney injury results in significant long term patient morbidity and mortality. Meanwhile, clinical trials are difficult and expensive, with an estimated median cost of $40,000 USD per enrolled patient. Thus, human trials are less frequently performed. Preclinical models and newer urinary biomarkers provide a feasible pathway to creating safer vancomycin treatment courses for patients. Positive findings can be carried forward to create Precision Dosing for vancomycin (i.e. drug optimization based on individual patient exposures and biomarkers that indicate sub-clinical toxicity).

Learning Objectives:

1. Describe the exposure-response relationships with vancomycin and acute kidney injury
2. Define biomarkers that may be useful to improve Precision Dosing