Random levels may be ordered when attempting to determine when to dose vancomycin in patients with renal impairment or those undergoing dialysis. Trough levels correlate better with efficacy than peak levels, with target trough levels of 10.0 and 20.0 mcg/mL, depending on the type of infection.
Full Answer
When to check Vanc trough?
- Low blood pressure
- Kidney toxicity
- Muscle spasms
- Allergic reactions such as hives, itching, or anaphylaxis
- Chills and fever
- Bruising at the IV insertion site
What is the normal range for vancomycin?
Vancomycin Test - Normal Range. Trough reference range: 10-20 µg/mL. Peak reference range: 30-50 µg/mL. Vancomycin is one of the most widely used antibiotics for the treatment of serious gram-positive infections involving methicillin-resistant S. aureus ( MRSA) and has been in clinical use for nearly 50 years.
How to measure vancomycin trough?
Vancomycin blood levels are drawn at timed intervals to measure drug levels during treatment. Vancomycin has a narrow therapeutic index, which is the ratio between the toxic and effective dose of medication. As soon as vancomycin enters the body, the drug gets distributed throughout, and then the kidneys begin to work to remove it from the body.
What is the therapeutic range for vancomycin?
- Data do not support using peak serum vancomycin concentrations to monitor for nephrotoxicity.
- Trough monitoring is recommended for patients receiving aggressive dosing (i.e. to achieve sustained trough levels of 15–20 mg/L) and all patients at high risk of nephrotoxicity (e.g. ...
- Monitoring is also recommended for patients with unstable (i.e. ...
What is a random vancomycin level?
Therapeutic: Peak: 20 - 40 mcg/mL, Trough: 5 - 20 mcg/mL; Critical: Peak/Random values: >60 mcg/mL; Trough values: >20.1 mcg/mL. Test Details. Daily, 24 hrs. 2 hours.
Why are trough levels drawn for vancomycin?
Abstract. Vancomycin trough levels are recommended to predict vancomycin efficacy, and inaccurate levels may lead to inappropriate clinical actions. However, the frequency of timing errors and associated clinical impact is unknown.
What is the difference between peak and trough?
The lowest level of the drug in the patient's body is called the trough level. The peak for a drug is when the level of the drug in the patient's body is the highest.
Why is peak and trough important?
Peak and trough levels are drawn to determine a drug's concentration within the system. They help determine if a drug is in a toxic range or if the dosage of the medication needs to be increased. It is important to know which medications need to be monitored and what the signs and symptoms of toxicity are.
Why is it important to monitor vancomycin levels?
Monitoring the level of vancomycin is important because its effectiveness relies on keeping blood levels above a minimum concentration for the entire duration of therapy (also referred to as total drug exposure).
Why is it important to individualize the dose of vancomycin?
To maintain this steady-state, it’s important to individualize the dose because each person’s body will process and remove vancomycin at different rates based upon their age, underlying health status, weight, kidney function, and other medications they are taking.
What is the benefit of Bayesian AUC?
A benefit of using Bayesian AUC estimates is it can be applied to all patients (including obese, critically-ill patients, pediatrics, and patients with kidney dysfunction). Currently, it is preferred to estimate the Bayesian AUC on two vancomycin concentrations (peak and trough).
What is the AUC of vancomycin?
In patients receiving vancomycin, a greater risk of nephrotoxicity occurs when doses exceed 4 grams per day and trough levels are higher than 15mcg/mL and an AUC above 600 mg-h/L is present. Vancomycin associated AKI can be measured in different ways, but a common definition of AKI used is either.
How long does it take to draw vancomycin?
A Bayesian approach allows vancomycin levels to be drawn within the first 24 to 48 hours instead of waiting for steady-state conditions (after the 3rd or 4th dose). This information can be used to change subsequent dosing.
What is the therapeutic index of vancomycin?
Vancomycin has a narrow therapeutic index, which is the ratio between the toxic and effective dose of medication. As soon as vancomycin enters the body, the drug gets distributed throughout, and then the kidneys begin to work to remove it from the body.
When was vancomycin first used?
Vancomycin can also be given before certain surgeries to prevent an infection. Although it was originally approved by the FDA in 1958, it was not widely used until the late 1970s when resistance to other antibiotics started to emerge.
Continue Watching
Spectrum Health Lakeland President Loren B. Hamel, MD, and Acting Health Officer at the Berrien County Health Department, Courtney Davis, share the latest COVID-19 updates in Berrien County.
Trending on Lakeland
A new level of molecular testing is now available at Spectrum Health Lakeland through a $350,000 investment in the cobas® 6800 System which allows for real-time PCR testing.
How high should vancomycin be?
To avoid development of resistance, vancomycin trough levels should remain above 10.0 mcg/mL. Complicated infections require higher target levels, typically 15.0 to 20.0 mcg/mL. Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic studies or for select patients.
What is vancomycin used for?
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), Streptococcus 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-lactam antibiotics.
What is the kinetic interaction of vancomycin?
The assay is based on the kinetic interaction of microparticles in solution (KIMS). Vancomycin antibody is covalently coupled to microparticles and the derivative is linked to a macromolecule. The kinetic interaction of microparticles in solutions is induced by binding of drug-conjugate to the antibody on the microparticles and is inhibited by the presence of vancomycin in the sample. A competitive reaction takes place between the drug conjugate and vancomycin in the sample. A competitive reaction takes place between the drug conjugate and vancomycin in the serum sample for binding to the vancomycin antibody on the microparticles. The resulting kinetic interaction of microparticles is indirectly proportional to the amount of drug present in the sample. (Package insert: Roche Vancomycin reagent, Roche Diagnostic Corp, Indianapolis, IN. 2016-09 Ver. 1)
How long after a peak should you draw serum?
In addition to this random assay, both peak level and trough level testing are available. 1. Serum for a peak level should be drawn 1 hour after completion of dose; order VANPA / Vancomycin, Peak, Serum. 2.
What are peaks and troughs?
Peaks and troughs are the highest and lowest concentrations of a medication in an individual’s body. They are used to determine dosing intervals, or how much time should pass between each new administration of the drug.
What do peak and trough levels indicate?
Peak and trough levels indicate drug levels in an individual’s body. A peak is the highest level of a medication in the blood, while a trough level indicates the lowest concentration. Troughs of medication concentration occur after the drug has been broken down and metabolized by the body.
When do you take peak and trough levels?
The time to take peak levels depends on the route of administration. The peak level is taken about 15 to 30 minutes after intravenous injections or infusions, 30 minutes to 1 hour after intramuscular injections, and about 1 hour after a drug is taken orally. Peak levels are delayed in order to allow the medication to distribute throughout the body.
What are the most important facts to know about peaks and troughs?
Peaks and troughs are the highest and lowest concentrations, respectively, of a medication in an individual’s body. They are used to determine dosing intervals, especially during therapeutic drug monitoring.
What is the trough level of vancomycin?
Traditionally it is recommended to get trough doses to assess efficiency. Typically, we aim for Vancomycin trough levels between 10-20µg/mL (15-20 µg/mL for more severe infections). WHY NOT MEASURE PEAKS?
When should trough concentrations be measured?
Trough concentrations should be measured within 30 minutes prior to infusion of the fourth dose or fifth dose. Why? This is when the drug (in fact all drugs) will reach steady state. NOTE: Can be measured before 3rd dose in patients which renal impairment and risk of toxicity may be greater.
Is vancomycin a time dependent bactericidal?
Vancomycin displays time-dependent bactericidal activity when above the minimum inhibitory concentration (MIC), not dose-dependent. Hence, there is little evidence to support the measurement of target peak concentrations.