Vancomycin IV Drug Monitoring

Note

Consult pharmacy for drug monitoring and interpretation as dosing is highly patient specific

Recommendations

  • Check pre-concentration: 0-1 hours before dose

  • Initial concentration: Prior to 3rd-4th dose for neonates and 5th-6th dose for infants/children

  • Subsequent concentrations: Once weekly for courses more than 7 days (twice weekly if receiving other nephrotoxic agents, elevated baseline serum creatinine, or pre-dose serum concentration target greater than 15mg/L)

  • Target 7-12 mg/L: Bacteremia including infections with coagulase negative staphylococci (e.g. S. epidermidis), skin or soft tissue infections caused by methicillin resistant Staphylococcus. aureus (MRSA; MIC less than 1 mcg/mL), or line infections

  • Target 12-15 mg/L: Suspected or documented bacterial meningitis sepsis, deep, severe soft tissue infections, pneumonia, osteomyelitis

  • Target 15-20 mg/L: RARELY indicated in children due to lack of clinical evidence of efficacy. Consider for infective endocarditis or infections with vancomycin sensitive organisms that fail therapy at lower pre-dose serum concentration

Monitor urine output daily and serum creatinine and CBC (to assess for neutropenia) weekly with pre-dose concentration