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Vancomycin monitoring



1.   Monitoring parameters:

Please note: patients with unstable renal function require more frequent monitoring:

Vancomycin trough level

Obtain at steady-state (approximately four half lives) and then at least weekly during therapy.

BUN and serum creatinine

Measure daily for the first 5 days then every two days, continue daily monitoring in unstable renal function.


Weigh patient every two to seven days.

Urine output

Measure and monitor urine output daily.

Baseline and weekly audiograms.
Check for signs of phlebitis daily. A central line is recommended for vancomycin infusions.


2.   Therapeutic serum concentrations (mcg/ml)

Although considerable controversy exists, the following target serum levels are currently recommended:

Routine peak level monitoring is no longer recommended
Trough level
For serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe SSTI (eg, necrotizing fasciitis) due to MRSA, vancomycin trough concentrations of 15–20 mcg/ml are recommended.
For less serious infections such as skin and soft tissue infections, trough concentrations of 10-15 mcg/ml are recommended.


3.   24-hr AUC/MIC ratio

This is a calculated parameter based on a measured steady-state trough level.
A 24-hr AUC/MIC ratio of at least 400 mg · h/liter will ensure efficacy.
The 24-hr AUC nephrotoxicity threshold for vancomycin has not been clearly defined.
Based on current data, it appears prudent to maintain the 24-hr AUC below 600 to minimize the risk of nephrotoxicity..


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