Therapeutic Monitoring of Vancomycin

Vancomycin level monitoring is a topic under constant consideration.

Vancomycin trough levels are the preferred test, though Vancomycin peak levels (drawn 3 hours after the dose), may be useful in rare situations when calculation of kinetic parameters are necessary. Vancomycin trough levels should be collected just prior to the 3rd or 4th dose (within 30 minutes prior to administration). Baseline creatinine levels should be measured prior to the start of therapy and weekly during therapy, unless renal function indicates more frequent testing.

Indications for Monitoring

Indications for monitoring include patients with therapy anticipated to be greater than three (3) to five (5) days, infants and children with serious infections, cerebrospinal fluid shunt infections, meningitis, patients with rapid clearance of drug, in selected dialysis patients, and in cases of deteriorating or unstable renal function. In these patients a trough level is recommended, rather than a peak level, as vancomycin is distributed slowly into the peripheral tissues, making it difficult to determine a true peak level.

Therapeutic Ranges

Therapeutic ranges for Vancomycin differ dependent upon the infection.

In those circumstances where levels between 15 and 20 mg/L are indicated, renal function must be monitored closely. The pharmacist should be consulted whenever levels exceed 20 mg/L.

Risk Factors

Risks factors of supratherapeutic dosing (levels over 20 mg/L) are the incremental risks of nephrotoxicity and ototoxicity. Levels below the therapeutic range increase the risk of treatment failure as well as the risk of resistance to the drug.

Reference:
Rybak, Michael, Lomaestro John, Rotschaer, John C, Moellering Jr, Robert, Craig, William, Billeter, Marianne, Dalovisio, Joseph R, Levine, Donald P, Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists the Infectious Diseases Society of America and the Society of Infectious Diseases Pharmacists. Am J Health Cyst Pharm – Vol. 66 Jan, 2009

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