Diagnostic Use
1. Checking peak levels for vancomycin is unnecessary. It does not add value to clinical management and this practice should be abandoned
2. The relationship between vancomycin and nephrotoxicity is not clear. Vancomycin is a rare cause of nephrotoxicity. However, it may contribute to nephrotoxicity when administered with other nephrotoxic agents such as aminoglycosides and amphotericin
3. Patients receiving prolonged courses of vancomycin treatment should have at least 1 steady-state trough level measured just before the fourth dose. Frequent monitoring for short-course (5 day) therapy is not recommended
4. Monitoring to prevent ototoxicity is not recommended, because this toxicity is rarely associated with monotherapy and does not correlate with serum level.
Reference Intervals
Vancomycin Dosing and Monitoring (Adult)*
*Prescribing requires Infectious Disease team or Clinical Microbiology approval
Since February 2013 a new vancomycin dosing and monitoring guideline has been in use. The ” vanculator ” should be used to calculate loading dose and initial maintenance dose of vancomycin in all adult patients.
See the Intranet for Vanculator: https://cmhealth.hanz.health.nz/Pages/Vanculator.aspx
Monitoring: Measure TROUGH levels only
| Vancomycin level: |
15 – 20 mg/L |
|
When to take a level:
|
Take a level within ONE hour before giving the next dose |
|
|
|
After commencement or change in dosing, to achieve steady state, allow three doses before measuring the trough level. |
Test Method
Principle: Turbidimetric Inhibition Immunoassay
Reagents: Siemens Atellica CH Vancomycin
Analyser: Siemens Atellica CH