Method of vancomycin target trough concentration monitoring in adults

The timing of the vancomycin trough plasma sample depends on whether vancomycin is being administered as an intermittent or continuous infusion, and the patient’s kidney function; see Recommended timing of vancomycin trough concentration sample and target trough ranges in adults. If an intermittent infusion is used, the plasma sample should be taken immediately (or within 60 minutes) before the next dose is due. If a continuous infusion is used, a random sample can be used.

Measure the vancomycin concentration at least weekly if the dose of vancomycin is stable (ie after 2 consecutive trough levels are within the target range). During dose optimisation, more frequent measurement is required (considering the time it takes for steady state to be achieved). More frequent monitoring may also be required in patients:

  • with reduced or changing kidney function
  • who are concomitantly being treated with nephrotoxins
  • when their clinical condition changes.
Table 1. Recommended timing of vancomycin trough concentration sample and target trough ranges in adults

Creatinine clearance

Timing of trough plasma sample [NB1]

Target range [NB2]

intermittent dosing

more than 60 mL/min

before the fourth dose

10 to 15 mg/LHaag 2023

20 to 60 mL/min [NB3]

twice-daily dosing: before the fourth dose

once-daily dosing: before the third dose

less than 20 mL/min [NB4]

before the second dose

continuous infusion

all patients

random sample around 24 hours after starting continuous infusion

17 to 25 mg/L

Note:

NB1: The timing of trough plasma samples depends on when steady state is achieved (which depends on the patient’s kidney function).

NB2: The recommended target ranges in this table do not apply to patients with central nervous system infection. See Vancomycin monitoring in adults with a central nervous system infection or seek expert advice.

NB3: For patients with creatinine clearance of 20 to 60 mL/minute, where there has not been an acute rise in creatinine and where toxicity is not suspected, it is not necessary to wait for the result to give the next scheduled dose.

NB4: For patients with a creatinine clearance less than 20 mL/min, the clinical context determines whether the next dose is given before the result is available or withheld until the result is known.