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In the last decades, vancomycin has been widely used in hospital environments due to the increasing incidence of sepsis and septic shock. Sepsis may lead to multiple organ failure; it is considered a risk factor for the development of acute kidney injury (<jats:styled-content style=\"fixed-case\">AKI<\/jats:styled-content>), with an overall mortality rate of around 45%, which can reach the surprising rate of 70% with the combination of <jats:styled-content style=\"fixed-case\">AKI<\/jats:styled-content> and sepsis. Considering the high mortality rate of sepsis and its related costs of hospitalization and treatment, specific measures should be adopted, such as early\u2010goal treatment protocols: proper and early administration of antimicrobials, fluids, vasoactive drugs and transfusion support. Besides the careful selection of the antimicrobial, another concern related to critically ill patients is the proper dose of the antimicrobial, since pharmacokinetic changes are observed due to drug absorption, distribution, metabolism and elimination. Gram\u2010positive pathogens are very common in hospitalized patients with septic shock, so vancomycin has been the antimicrobial of choice for more than 60\u00a0years. However, discussions about its dosage, administration and monitoring are extremely important, considering the risk of nephrotoxicity and the emergence of resistant <jats:italic>S.\u00a0aureus<\/jats:italic>. This narrative review aims to discuss controversial aspects related to the efficacy and safety of vancomycin, correlating them with data available in the literature and identifying knowledge gaps in guide future lines of research.<\/jats:p>","DOI":"10.1111\/1440-1681.13066","type":"journal-article","created":{"date-parts":[[2019,1,9]],"date-time":"2019-01-09T13:29:48Z","timestamp":1547040588000},"page":"292-301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-6621","authenticated-orcid":false,"given":"Welder","family":"Zamoner","sequence":"first","affiliation":[{"name":"Botucatu School of Medicine University S\u00e3o Paulo State\u2010UNESP Botucatu Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iara Ranona 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