1. Monitoring parameters:
Please note: patients with unstable renal function require more frequent monitoring:
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.
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 |
|•||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..|