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Vancomycin monitoring
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.. |
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