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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Infectious Diseases

Background:

  • Increased vancomycin use necessitates understanding its pharmacokinetics.
  • Serum drug concentration monitoring is vital for optimizing vancomycin therapy.
  • Vancomycin exhibits significant inter- and intrapatient variability in disposition.

Purpose of the Study:

  • To evaluate the necessity and feasibility of vancomycin serum drug concentration monitoring.
  • To assess the correlation between vancomycin levels, efficacy, and toxicity.
  • To develop guidelines for streamlined vancomycin monitoring.

Main Methods:

  • Literature review and pharmacokinetic data analysis from Vancouver Hospital.
  • Evaluation of 371 vancomycin treatment courses.
  • Development of empiric dosage guidelines and a decision-making algorithm.

Main Results:

  • Vancomycin meets criteria for serum concentration monitoring: available assay, significant variability, and links to efficacy/toxicity.
  • Interpatient variability in clearance and volume of distribution complicates dose prediction.
  • Increasing half-life during treatment requires dose interval adjustments; creatinine and weight are poor predictors.

Conclusions:

  • Vancomycin serum concentration monitoring remains essential despite challenges.
  • High trough concentrations may correlate with nephrotoxicity.
  • Developed guidelines and algorithms improve vancomycin prescribing and monitoring efficiency.