Target ranges for vancomycin trough concentration monitoring in adults

Vancomycin trough plasma concentration measurement can be used as a surrogate for area under the concentration–time curve over a 24-hour period (AUC₂₄).

In these guidelines, the target range for vancomycin trough concentration for intermittent infusion dosing in adults is 10 to 15 mg/L. Recent data show that trough concentrations of 10 to 15 mg/L generally achieve an AUC₂₄ of 400 mg.hr/L (required for efficacy) while remaining below an AUC₂₄ of 600 mg.hr/L (associated with nephrotoxicity)Chen 2022Haag 2023.

In some patients, concentrations at the lower end of the trough target range (eg 10 or 11 mg/L) may not achieve an AUC₂₄ of 400 mg.hr/LChavada 2017. In situations where the risk of not achieving an AUC₂₄ of 400 mg.hr/L is unacceptable (eg patients who are critically ill or unstable, patients with severe, necrotising or deep-seated infections, patients with suspected or confirmed Staphylococcus aureus bacteraemia), AUC₂₄ monitoring should be used. If this is not possible, to increase the likelihood of achieving an AUC₂₄ of above 400 mg.hr/L, a trough concentration at the upper end of the trough target range may be preferred.

Low trough concentrations (eg less than 10 mg/L) have been associated with clinical treatment failure and emergence of vancomycin heteroresistance among S. aureus isolatesCharles 2004Martirosov 2017.