Vancomycin, Random, Serum
Monitoring adequacy of drug concentration during vancomycin therapy
This unit code is used whenever a specimen is submitted or collected without collection timing information. Random levels may be ordered when attempting to determine when to dose vancomycin in patients with renal impairment or those undergoing dialysis.
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Vancomycin is an antibiotic used to treat infections caused by gram-positive organisms that are resistant to beta-lactam antibiotics, such as methicillin-resistant staphylococci (MRSA), Staphylococcus viridans group, penicillin/cephalosporin-resistant Streptococcus pneumoniae, and penicillin/ampicillin-resistant Enterococcus species. The oral formulation, which is not absorbed, is used in the treatment of pseudomembranous colitis caused by Clostridium difficile. Vancomycin is also used when patients are intolerant or allergic to beta lactams.
Vancomycin has been associated with nephrotoxicity and ototoxicity, although it appears that many of these reports reflected impurities in early formulations. Monitoring of vancomycin-related nephrotoxicity is recommended only for patients with reduced renal function, those receiving aggressive or prolonged vancomycin regimens, or those at high risk including patients comedicated with other nephrotoxic agents.
Trough concentrations are recommended for therapeutic monitoring of vancomycin, preferably acquired at steady state (just before fourth dose). To avoid development of resistance, vancomycin trough levels should remain >10 mcg/mL. Complicated infections require higher target levels, typically 15 to 20 mcg/mL. Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic studies or for select patients.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Therapeutic concentration: 10.0-20.0 mcg/mL
Complicated infections: 15.0-20.0 mcg/mL
Therapeutic concentration: 25.0-50.0 mcg/mL
Trough levels correlate better with efficacy than peak levels, with target trough levels of 10 and 20 mcg/mL, depending on the type of infection.
Peak levels are not recommended for monitoring, except in select circumstances such as when performing pharmacokinetic analyses (eg, area under the curve [AUC] determinations). Typical peak levels are between 25 and 50 mcg/mL.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic drug monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009;66:82-98
2. Estes L, Wilson J: Mayo Guide to Antimicrobial Therapy, Mayo Clinic, 2005-2008