The Therapeutic Drug Monitoring of Vancomycin: Mathematical Complexity and the Role of Digital Tools in Risk Reduction – A Systematic Review

Authors

DOI:

https://doi.org/10.36557/2674-9432.2026v5n3p154-173

Keywords:

Vancomycin, AUC/MIC, Clinical Pharmacokinetics, Mathematical Modeling, Educational Technologies

Abstract

Background: The transition of vancomycin monitoring to the Area Under the Curve to Minimum Inhibitory Concentration (AUC/MIC) ratio aims to increase therapeutic safety. However, the complexity of mathematical modeling and Bayesian estimation poses significant challenges to clinical practice. Persistent educational gaps and the phenomenon of "mathophobia" among healthcare professionals can compromise dosing precision, especially in critically ill patients. Objective: This systematic review aimed to examine the correlation between vancomycin dose calculation using the AUC/MIC index and the formative gaps of healthcare professionals in the domains of mathematical modeling, clinical pharmacokinetics, and educational technologies. Methods: Following the PRISMA 2020 protocol, the search was conducted between January 2015 and February 2026 in the PubMed, Scopus, Web of Science, and SciELO databases. Inclusion criteria were used to select studies addressing AUC/MIC monitoring related to professional knowledge or the use of assistive tools. Results: From 550 identified records, 10 articles were included in the final synthesis. The results reveal significant insufficiencies in the understanding of the AUC/MIC method, evidenced by an average knowledge score in Therapeutic Drug Monitoring (TDM) of only 50.3%. Findings highlight that digital tools and the use of Large Language Models (LLMs) are essential strategies to mitigate the mathematical complexity of the process. Conclusion: The review highlights the urgent need for an integrated digital educational tool (such as the proposed VANCOLEARN project) capable of articulating mathematical fundamentals and safe clinical practice. It is concluded that developing technological resources that simplify the application of AUC/MIC is fundamental to overcoming educational barriers and ensuring the advancement of clinical pharmacokinetics teaching.

Downloads

Download data is not yet available.

Author Biographies

Robson Rodrigues da Silva, UNIVERSIDADE DE MOGI DAS CRUZES

Holds a Bachelors and Teaching Degree in Mathematics from the Universidade de Mogi das Cruzes (1992), a Masters degree in Science (Mathematics) from the Universidade de São Paulo (2004), a PhD in Biomedical Engineering from Universidade de Mogi das Cruzes (2012), and a Postdoctoral degree in Bioengineering from the Center for Biomedical Engineering at Universidade Estadual de Campinas (2018).Currently, is a professor at Universidade de Mogi das Cruzes (UMC), where also serves as a researcher at the Technological Research Center (NPT/UMC), affiliated with the Graduate Program in Biomedical Engineering. Is a full member of the Research Ethics Committee (CEP/UMC), coordinator of the Mathematics Laboratory (LabMat/UMC), and Vice Coordinator of the Graduate Program (Masters and PhD) in Biomedical Engineering at UMC.Is a collaborating researcher at the Laboratório Nacional para Estudo do Cálcio Celular, affiliated with the Center for Biomedical Engineering at Universidade Estadual de Campinas, and a scientific advisor to the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Coordinates a FAPESP-funded project (process 2016/18422-7), entitled Implementation, evaluation and comparison of contraction force and/or cell shortening models for rat ventricular myocytes.Has experience in Mathematics and Biomedical Engineering (Bioengineering), with emphasis on Differential and Integral Calculus, Algebra, and Modeling of Biological Systems and Phenomena, mainly working on mathematical modeling and computational simulation of cardiac electrophysiology, as well as applications of differential and integral calculus to biological systems.

Fabiano Bezerra Menegidio, UNIVERSIDADE DE MOGI DAS CRUZES

Coordinator of the Integrated Graduate Program in Biomedical Engineering and of the Technological Research Center (NPT) at the Universidade de Mogi das Cruzes (UMC). Coordinator of the Bioinformatics and Omics Sciences Laboratory (LaBiOmicS), affiliated with the Integrated Biotechnology Center (NIB) and the Technological Research Center (NPT), both at UMC. Faculty member of the stricto sensu graduate programs in Biomedical Engineering and Biotechnology at UMC. Leads research projects in Bioinformatics focused on Transcriptomics, Genomics, Metabolomics, Microbiome, and Metagenomics, within the fields of Biotechnology and Biomedical Engineering. Co-founder and Chief Technology Officer (CTO) of the biotechnology-based startups EasyOmics and Brycon Soluções Biotecnológicas.

References

Albassam, A. et al. Knowledge, Confidence, and Perception Toward Therapeutic Drug Monitoring Among Physicians and Pharmacists in Kuwait. Therapeutic Drug Monitoring, v. 44, n. 4, p. 511-519, 2022. doi: 10.1097/FTD.000000000000000966

Alghanem, S. S. et al. Awareness, perception, and barriers of healthcare professionals toward AUC₍₂₄₎/MIC monitoring of vancomycin. Antibiotics, v. 12, n. 5, p. 719, 2023. doi: 10.1016/j.jsps.2023.04.025

Al-Jazairi, A. S. et al. Impact of a Clinical Decision Support System on Vancomycin AUC-Based Dosing and Therapeutic Monitoring: A Before-and-After Study. International Journal of Clinical Pharmacy, v. 45, n. 2, p. 412-421, 2023. https://link.springer.com/journal/11096/volumes-and-issues/45-2

Britannica. Vancomycin. Encyclopaedia Britannica, 2025.https://www.britannica.com/science/vancomycin

Carou-Senra, P. et al. Exploring the Role of LLMs Like ChatGPT in Pharmacy Education for Supporting Students' Therapeutic Decision-making. American Journal of Pharmaceutical Education, 2025. https://doi.org/10.1016/j.ajpe.2025.101462

Crass, R. L. et al. Pharmacokinetics-Informed Precision Dosing: A Survey of Pharmacists’ Knowledge and Attitudes Toward Bayesian Forecasting Tools. Journal of the American College of Clinical Pharmacy, v. 6, n. 3, p. 245-253, 2023.

Dzif – Deutsches Zentrum für Infektionsforschung. Vancomycin – Glossary] Entry, 2025.

https://www.dzif.de/de/glossar/vancomycin

Feferbaum, R. et al. Vancomycin monitoring in term newborns: comparison of peak and trough serum concentrations... Revista do Hospital das Clínicas da Faculdade de Medicina de São Paulo, v. 56, n. 5, p. 149 152, 2001. issn: 1678-9903

Fleuren, L. M. et al. Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross sectional study. Critical Care, v. 23, art. 185, 2019. doi: 10.1186/s13054-019-2438-1

Goud, R. et al. Community prevalence of methicillin and vancomycin resistant Staphylococcus aureus... Revista da Sociedade Brasileira de Medicina Tropical, v. 44, n. 3, p. 309 312, 2011. doi: 10.1590/s0037-86822011005000035

Hei, H. M. et al. Development and Validation of a Mobile Application for Vancomycin AUC/MIC-Based Dosing in Neonatal Intensive Care Units. Frontiers in Pharmacology, v. 14, p. 1152048, 2023. https://doi.org/10.3389/fphar.2023.1151560

Jelliffe, R. et al. Individualized Patient Care Through Model-Informed Precision Dosing: Reflections on Training Future Practitioners. Therapeutic Drug Monitoring, v. 44, n. 4, p. 556-562, 2022. doi: 10.1208/s12248-022-00769-z

Liu, J. et al. Is it time to recommend AUC based vancomycin dosing? A survey of hospitals in China. Frontiers in Pharmacology, v. 15, p. 1370040, 2024. doi: 10.3389/fphar.2024.1370040

Machado, J. K. K. et al. Monitoring the treatment of sepsis with vancomycin in term newborn infants. Revista do Hospital das Clínicas da Faculdade de Medicina de São Paulo, v. 56, n. 1, p. 17 24, 2001. doi: 10.1590/s0041-87812001000100004

Melo, A. G.; Struchiner, M.; Frant, J. B. A matemática da administração de medicamentos. Revista de Estudos e Pesquisas sobre Ensino Tecnológico, 2022. issn 2446-774X

Morales Júnior, R. et al. Monitoramento terapêutico de vancomicina: barreiras na implementação do AUC/MIC. Revista Saúde em Foco, 2023.

http://www4.unifsa.com.br/revista/index.php/saudeemfoco

Oda, K. et al. Performance of Area under the Concentration-Time Curve Estimations of Vancomycin with Limited Sampling by a Newly Developed Web Application. Pharmaceutical Research, v. 38, n. 4, p. 637-646, 2021. doi: https://doi.org/10.1007/s11095-021-03030-y

Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews, v. 10, n. 1, p. 89, 2021. doi: https://doi.org/10.1136/bmj.n71

Pedmed. Vancomycin AUC/MIC Therapeutic Drug Monitoring Guideline, 2025. www.pedmed.org

Shargel, L.; Wu Pong, S.; Yu, A. B. C. Applied Biopharmaceutics & Pharmacokinetics. 6. ed. New York: McGraw Hill, 2012. Applied Biopharmaceutics & Pharmacokinetics

Silva, A. C. et al. Elaboração e validação de tecnologia educativa de introdução a farmacologia, farmacocinética e farmacodinâmica. Brazilian Journal of Health Review, 2023. doi: 10.34119/bjhrv6n1-163

Suzuki, A. et al. Identification of Patients Who Require Two-Point Blood Sampling for the Peak and Trough Values Rather Than One-Point Blood Sampling for the Trough Value for the Evaluation of AUC of Vancomycin Using Bayesian Estimation. Pharmaceutical Research, v. 41, n. 11, p. 2161-2171, 2024. https://doi.org/10.1007/s11095-024-03781-4

Tdm Monograph. Vancomycin, 2025. doi: 10.1097/MD.0000000000042952

Turner, R. B. et al. Implementation of Bayesian Vancomycin Monitoring: Professional Gaps and the Role of Simulation-Based Training. Journal of Pharmacy Practice, v. 37, n. 1, p. 88-95, 2024. https://journals.sagepub.com/toc/jppa/37/1

Al-dujaili, Z. et al. Assessing the accuracy and consistency of ChatGPT in clinical pharmacy management: A preliminary analysis with clinical pharmacy specialists worldwide. Research in Social and Administrative Pharmacy, v. 20, n. 2, p. 166-171, 2024. https://doi.org/10.1016/j.sapharm.2023.08.012

Downloads

Published

2026-05-03

How to Cite

RODRIGUES DA SILVA, Roger; RODRIGUES DA SILVA, Robson; BEZERRA MENEGIDIO, Fabiano. The Therapeutic Drug Monitoring of Vancomycin: Mathematical Complexity and the Role of Digital Tools in Risk Reduction – A Systematic Review. Periódicos Brasil. Pesquisa Científica, Macapá, Brasil, v. 5, n. 3, p. 154–173, 2026. DOI: 10.36557/2674-9432.2026v5n3p154-173. Disponível em: https://periodicosbrasil.emnuvens.com.br/revista/article/view/938. Acesso em: 15 may. 2026.

Issue

Vol. 5 No. 3 (2026): Periódicos Brasil. Pesquisa Científica - QUALIS A3

Section

Ciências da Saúde

License

Copyright (c) 2026 Roger Rodrigues da Silva, Rodrigues, Menegidio

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Você tem o direito de:

  1. Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato para qualquer fim, mesmo que comercial.
  2. Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial.
  3. O licenciante não pode revogar estes direitos desde que você respeite os termos da licença.  

 

De acordo com os termos seguintes:

  1. Atribuição — Você deve dar o crédito apropriado , prover um link para a licença e indicar se mudanças foram feitas . Você deve fazê-lo em qualquer circunstância razoável, mas de nenhuma maneira que sugira que o licenciante apoia você ou o seu uso.
  2. Sem restrições adicionais — Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.