Laurie Briceland, PharmD

Disclosures

October 20, 2005

Question

It is my understanding that the literature recommends no vancomycin trough levels unless the patient falls within certain exclusion criteria (ie, changing renal function, CNS infection, etc). Is this correct?

Response From the Expert

Laurie Briceland, PharmD 
Professor and Director Experiential Education, Department of Pharmacy Practice, Albany College of Pharmacy, Albany, New York.

Correct. The primary goal of therapeutic drug monitoring and subsequent dosage adjustment is to optimize serum drug concentrations for patients receiving agents with a narrow therapeutic index. In light of the fact that the frequency of nephrotoxicity with vancomycin is low,[1,2] coupled with the understanding that the efficacy of vancomycin, a compound with concentration-independent pharmacodynamic characteristics, does not correlate with serum concentrations, the need for vancomycin monitoring has been questioned.

Many clinicians have abandoned the practice of routine pharmacokinetic monitoring as a guide for vancomycin dosing[1,2,3,4] and instead advocate monitoring the vancomycin serum concentrations in patients at risk for nephrotoxicity. Examples of such at-risk patients include those receiving concomitant aminoglycoside antimicrobials; those with changing renal function; those receiving higher than normal doses necessitated by infections with resistant organisms; and those receiving dialysis with unconventional high-flux filter membranes.[5,6]

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