Abstract:

Vancomycin is a key glycopeptide antibiotic for the treatment of Gram-positive bacterial infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). However, significant pharmacokinetic (PK) heterogeneity in pediatric patients makes it difficult for traditional dosing regimens to balance efficacy and nephrotoxicity risk. Model-Informed precision dosing (MIPD) strategies provide a novel approach for individualized, AUC_0-24h/MIC-guided therapy by integrating quantitative pharmacological models (such as PPK, PBPK, and machine learning models) with individual patient data. Compared to conventional TDM, MIPD strategies significantly enhance the attainment rate of pharmacokinetic/pharmacodynamic (PK/PD) target concentrations (e.g., AUC), shorten the time to target attainment, especially in neonates and critically ill patients, and effectively reduce the risk of nephrotoxicity. This review summarizes the clinical value of MIPD-guided vancomycin application in neonates, critically ill children, and children with special disease conditions, intending to provide a reference for clinical practice.

Key words: model-informed precision dosing, vancomycin, population pharmacokinetics, efficacy, safety, pediatrics