Safe and effective use of vancomycin

Vancomycin is an important antimicrobial for prophylactic, empirical and directed therapy of Gram-positive organisms. Therapeutic drug monitoring is recommended for all patients expected to receive vancomycin for more than 48 hours to optimise drug exposure. Monitoring the area under the concentration-time curve over a 24-hour period (AUC₂₄) for vancomycin is preferred over monitoring trough plasma concentrations. An AUC₂₄ of 400 to 600 mg.hr/L is recommended for infections other than central nervous system infections. Vancomycin may cause nephrotoxicity, ototoxicity, cutaneous reactions, hypersensitivity and haematological toxicity. Reducing the incidence of vancomycin-induced nephrotoxicity involves recognising and modifying risk factors where possible.