TABLE 1

Highlights of the Recommendation for Vancomycin Monitoring in Adult Patients

VariableRecommendationComment
Monitoring of peaksPeak concentrations should no longer be routinely monitored.Because of vancomycin’s time-dependent nature, and the fact that an AUC:MIC ratio of 400 is the best predictor of clinical efficacy, peaks are not thought to be of therapeutic advantage.
Monitoring of troughsTrough concentrations are considered to be the best predictor of clinical efficacy, and are most practical for monitoring.An AUC:MIC ratio ≥400 has been shown by various studies to be the best marker for vancomycin efficacy, but because of the difficulty of calculating the AUC in a clinical setting, trough concentrations should be used as a surrogate marker.
Target trough concentrationsTroughs should be maintained at or above 10 mg/L. For pathogens with an MIC of >1 mg/L, trough concentrations should be targeted at 15–20 mg/L.Trough concentrations should not fall below 10 mg/L to avoid developing pathogen resistance. Concentrations above 10 mg/L will help attain a higher AUC:MIC ratio and address the growing problem of higher MIC values to vancomycin in susceptible organisms. For pathogens with an MIC ≥1 mg/L, the trough must be kept between 15 and 20 mg/L to achieve the target AUC:MIC ratio of 400.
Target trough concentrations for complicated infectionsTrough concentrations should be maintained between 15 and 20 mg/L for the following infections:Troughs of 15–20 mg/L should be targeted in these serious infections to increase antibiotic penetration and increase the likelihood of obtaining an AUC:MIC ratio of 400.
- Bacteremia
- Endocarditis
- Osteomyelitis
- Meningitis
- Hospital-acquired pneumonia caused by Staphylococcus aureus
Pathogens with high MIC values to vancomycinFor pathogens that have an MIC value of ≥2 mg/L, an alternative therapy to vancomycin should be considered.Because an AUC:MIC ratio of 400 is unlikely to be obtained for pathogens with an MIC ≥2 mg/L, an alternative drug therapy to vancomycin should be considered in these patients.