Population Pharmacokinetic Modelling of Vancomycin in Asian Neonates: A Narrative Review to Optimise Dosing Strategies
DOI:
https://doi.org/10.70672/racsb357Keywords:
Dosing regimen, neonates, modelling/modeling, neonates, vancomycinAbstract
Vancomycin exhibits highly variable pharmacokinetics (PK) in neonates, making standard dosing strategies often inadequate. This narrative review evaluates the current landscape of population pharmacokinetic (PopPK) modeling in Asian neonates to optimise dosing strategies. A comprehensive literature search was conducted across PubMed to locate English-language studies published between 2010 and 2025. Studies were selected if they utilised nonlinear mixed-effects modelling to describe vancomycin PK in Asian neonatal cohorts. Data regarding model structure, significant covariates, and validation methods were extracted from 11 identified studies, encompassing 1,359 neonates across six countries, and synthesised narratively. Findings indicate that body weight is the universal predictor for clearance (CL) and volume of distribution (Vd), while renal maturation markers (serum creatinine and postmenstrual age) significantly influence CL. Dynamic NICU factors, including daily fluid intake, diuretics, and vasoactive agents, were also found to critically impact drug disposition. While traditional efficacy targets use an AUC24/MIC≥400, evidence suggests a neonatal-specific target of 240–480 may be safer for this population. Nephrotoxicity risk was notably increased at an AUC24 threshold ≥ 485 mg·h/L. Collectively, these models demonstrate that trough-only monitoring is an inaccurate surrogate for total exposure. The review advocates for the adoption of Bayesian-derived pharmacokinetics estimates for AUC monitoring and the development of localised PopPK models to ensure precision dosing and therapeutic safety in Asian neonatal subpopulations.
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