Vnitr Lek 2014, 60(10):846-851

Therapeutic monitoring of vancomycin in routine clinical practice

Ivana Kacířová^1,2,*, Milan Grundmann¹

¹ Ústav klinické farmakologie LF OU Ostrava, přednosta doc. MUDr. Milan Grundmann, CSc.

² Oddělení klinické farmakologie Ústavu laboratorní diagnostiky FN Ostrava, primářka MUDr. Ivana Kacířová, Ph.D.

Therapeutic drug monitoring (TDM) is specific method of clinical pharmacology for monitoring of the therapy using measurement of drug serum concentrations followed interpretation and good cooperation with clinician. TDM help clinicians to quickly optimize vancomycin dosing regimens to maximize the clinical effect and minimize the toxicity of the drugs. Minimum serum vancomycin trough concentrations should always be maintained above 10 mg/L to avoid development of resistance, neverthelles trough concentrations > 20 mg/L are not recommended because of the risk of nephrotoxicity. For serious infections vancomycin trough concentrations of 15-20 mg/L are recommended and for a pathogen with an MIC of 1 mg/L, the minimum trough concentration would have to be at least 15 mg/L to generate the target AUC₂₄/MIC ≥ 400 (area under the curve/minimal inhibitory concentration). In non-complicated infections trough concentrations of 10-15 mg/L should be sufficient. For continuous infusions of vancomycin target steady-state concentration values of 15-25 mg/L have been advocated for critically ill patients.

Keywords: therapeutic monitoring; trough concentration; vancomycin

Received: May 7, 2014; Accepted: June 17, 2014; Published: October 1, 2014  Show citation