{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T22:27:34Z","timestamp":1787092054071,"version":"build-2736575974"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"\n Background<\/jats:title>\n Optimizing vancomycin therapy requires balancing efficacy and toxicity. Although therapeutic drug monitoring (TDM) guided by area-under-the-curve (AUC) measurements is now recommended, the effect of dosing frequency and patient-specific factors remain underexplored. This study examined the relationships of dosing frequency, pharmacokinetic\/pharmacodynamic (PK\/PD) parameters, clinical efficacy, and toxicities in patients receiving different vancomycin regimens.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study analyzed 193 vancomycin dosing regimens in 148 adult patients who were treated at a tertiary teaching hospital in China between January 2013 and March 2021, 175 of which were guided by TDM. The full TDM-guided cohort (n = 175) was used for analysis of safety and PK; clinical efficacy was assessed in 59 culture-confirmed cases; and the association of PK\/PD parameters with efficacy was examined in the 26 patients who received a 1\u00a0g q12\u00a0h regimen for staphylococcal infections.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the subset of 26 patients with staphylococcal infections who received the 1\u00a0g q12\u00a0h regimen, clinical success was not significantly associated with C\n trough<\/jats:sub>\n , AUC, or AUC\/minimum inhibitory concentration (AUC\/MIC). For the entire TDM-guided cohort, dosing frequency was a significant and independent determinant of C\n trough<\/jats:sub>\n (P = 0.031), in that more frequent dosing led to higher C\n trough<\/jats:sub>\n values without altering total daily AUC. Receiver operating characteristic (ROC) analysis indicated that AUC was a better predictor of nephrotoxicity (AUROC = 0.754) than C\n trough<\/jats:sub>\n (AUROC = 0.659). Multivariate analysis confirmed that pre-treatment creatinine clearance was the primary predictor of post-treatment renal function. Female gender was an independent risk factor for post-treatment anemia (P = 0.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Among the 26 patients with staphylococcal infections receiving the 1\u00a0g q12\u00a0h regimen, traditional PK\/PD targets (C\n trough<\/jats:sub>\n and AUC\/MIC) did not correlate with clinical efficacy in this real-world setting. AUC was a better predictor of nephrotoxicity than C\n trough<\/jats:sub>\n , and female gender was an independent risk factor for vancomycin-associated anemia.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fphar.2026.1843465","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T22:10:23Z","timestamp":1787091023000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing vancomycin therapy: the critical role of dosing frequency, AUC monitoring and gender: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Naiju","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Anhui Engineering Technology Research Center of Biochemical Pharmaceutical, National Clinical Research Center for Infectious Diseases, Institute of Emergency and Critical Care Medicine, First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Antibiotics, Huashan Hospital, and Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People\u2019s Republic of China, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longyun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Anhui Engineering Technology Research Center of Biochemical Pharmaceutical, National Clinical Research Center for Infectious Diseases, Institute of Emergency and Critical Care Medicine, First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Surgery, Institute of Emergency and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Bengbu Medical University","place":["Bengbu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1002\/phar.2722","article-title":"Vancomycin area under the curve versus trough only guided dosing and the risk of acute kidney injury: systematic review and meta-analysis","volume":"42","author":"Abdelmessih","year":"2022","journal-title":"Pharmacotherapy"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1093\/cid\/ciz051","article-title":"Vancomycin area under the curve and acute kidney injury: a meta-analysis","volume":"69","author":"Aljefri","year":"2019","journal-title":"Clin. 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