A review of vancomycin therapeutic drug monitoring recommendations in Scotland

Link: A review of vancomycin therapeutic drug monitoring recommendations in Scotland -- Helgason et al. 61 (6): 1398 -- Journal of Antimicrobial Chemotherapy.

Confusion continues regarding the therapeutic monitoring of vancomycin. Most clinicians would agree that the analysis of peak concentrations is of limited value due to both the pharmacodynamic (time-dependency) and pharmacokinetic (multiexponential decline) properties of vancomycin.1 However, there is still a lack of uniformity with respect to trough concentrations. The historical recommendation of 5–10 mg/L was based on efficacy data from in vitro experiments, protein-binding information and early concerns about nephrotoxicity. However, recent evidence suggests that nephrotoxicity is rare with vancomycin monotherapy