Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists

In general, pharmacodynamic dosing of antibiotics may significantly augment antibiotic performance. There seems to be little difference in the pharmacodynamics of intermittently or continuously dosed vancomycin. This consensus panel review supports that vancomycin is a concentration-independent killer of gram-positive pathogens and that the AUC/MIC is likely the most useful pharmacodynamic parameter to predict effectiveness. In many clinical settings where it may be difficult to obtain multiple serum vancomycin concentrations to determine the AUC and subsequently the AUC/MIC, trough serum vancomycin concentration monitoring can be recommended as the most accurate and practical method to monitor serum vancomycin levels. Increasing trough serum vancomycin concentrations to 15-20 mg/L to obtain an increased AUC/MIC of ≥400 may be desirable but is currently not supported by clinical trial data. Target attainment of an AUC/MIC of ≥400 is not likely in patients with S. aureus infections who have an MIC of ≥2 mg/L; therefore, treatment with alternative agents should be considered. Higher trough serum vancomycin levels may also increase the potential for toxicity, but additional clinical experience will be required to determine the extent of this potential.