Klin Farmakol Farm. 2016;30(2):4-8 | DOI: 10.36290/far.2016.012

Therapeutic monitoring of vancomycin in clinical practice

Hana Suchánková, Martina Machačová, Tereza Herodesová

Ústav farmakologie FN Olomouc

Introduction and objective: Routine therapeutic drug monitoring (TDM) of vancomycin is recommended in clinical practice in

order to optimize dosing and drug exposure. Recent guidelines on vancomycin TDM recommend monitoring of only through

concentrations with rather higher target ranges for dosage adjustment. The aim of the study was to evaluate the practice of vancomycin

TDM in University Hospital in Olomouc and to assess the potential influence of new recommendations on dosing strategies.

Methods: A retrospective analysis of vancomycin plasma levels determined during a two-year period was performed. Values with

uncertain sample timing and patients on haemodialysis were excluded. The values were assessed according to the older and the

new guidelines. Consecutively, pharmacokinetic modelling was performed for every patient to estimate individual PK/PD indices.

Results: A total of 468 vancomycin concentrations were included, which represented 260 events of monitoring performed in 131

patients. Vancomycin was mostly used for suspected or proven sepsis (49.6 % of all patients). Pathogens with MIC > 1 mg/L were

responsible for 18.5 % of all infections. Clinical pharmacologist trained in TDM was consulted in 18.1 % of all events. According to

the new guidelines, patients were underdosed in 38.5 % of the events, and overdosed in 39.2 % of the events of monitoring. PK

simulations showed suboptimal dosing in 28.1 % of the events, and too high dosing in 36.9 % of the events.

Conclusion: Dosage adjustments based only upon pre-dose concentrations may be inappropriate, especially if the value is interpreted

by a person with lack of experience in the field of TDM.

Keywords: pharmacokinetics, pharmacodynamics, vancomycin, dosing, trough

Published: September 19, 2016  Show citation