Elsevier

The Lancet

Volume 344, Issues 8939–8940, 24 December 1994, Pages 1748-1750
The Lancet

Clinical Practice
Why monitor peak vancomycin concentrations?

https://doi.org/10.1016/S0140-6736(94)92890-8Get rights and content

Abstract

Summary

Peak and trough serum concentrations are routinely measured to monitor vancomycin therapy. Optimal therapy depends upon maintaining a concentration above that necessary for antibacterial activity and is therefore determined by the trough concentration. I determined the post dose increases in serum drug concentrations in routine clinical practice in adult patients without renal failure. Mean increases of 16·6 mg/L (SD 6·1) (peak samples collected 1 h post infusion) were measured from 165 paired samples. The results suggest that as long as trough concentrations do not exceed 15 mg/L, peak levels will not exceed normally accepted safe concentrations, and therefore do not need to be measured.

References (18)

  • Ew Hook et al.

    Vancomycin therapy of bacterial endocarditis

    Am J Med

    (1978)
  • Tg Cantu et al.

    Serum vancomycin concentrations: reappraisal of their clinical value

    Clin Infect Dis

    (1994)
  • RC. Moellering

    Editorial: monitoring serum vancomycin levels: climbing the mountain because it is there

    Clin Infect Dis

    (1994)
  • Dj Edwards et al.

    Routine monitoring of serum vancomycin concentrations: waiting for proof of its value

    Clin Pharmacol

    (1987)
  • Ka Rodvold et al.

    Routine monitoring of serum vancomycin concentrations: can waiting be justified?

    Clin Pharmacol

    (1987)
  • Cd Freeman et al.

    Vancomycin therapeutic drug monitoring: is it necessary?

    Ann Pharmacol

    (1993)
  • We Peetermans et al.

    Antistaphylococcal activities of teicoplanin and vancomycin in vitro and in an experimental infection

    Antimicrob Agents Chemother

    (1990)
  • Bh Ackerman et al.

    Analysis of vancomycin time-kill studies with Staphylococcus species by using a curve stripping program to describe the relationship between concentration and pharmacodynamic response

    Antimicrob Agents Chemother

    (1992)
There are more references available in the full text version of this article.

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    Citation Excerpt :

    There has been considerable controversy in the literature over the utility of vancomycin serum concentration monitoring due to the lack of clinical trials relating specific vancomycin serum concentrations to clinical outcome [1–3,20,27]. Monitoring of peak serum concentrations now appears to be of little value, due to the time-dependent antimicrobial activity of vancomycin, the lack of a clear correlation between specific serum concentrations and toxicity, as well as, significant practical issues involved in obtaining a comparable and reliable peak concentration due to the multicompartment pharmacokinetics of the drug [3,4,28], the difficulty of which has been demonstrated in the Australasian setting [29]. Trough vancomycin concentrations remain of value to clinicians; in part due to the finding that vancomycin exerts maximal antibacterial effects at concentrations of 4–5 times the MIC [19,30,31].

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