What does peak and trough mean for Vancomycin (vancomycin hydrochloride)?

From the Guidelines

Vancomycin trough levels should be monitored and maintained between 15-20 mcg/mL for serious infections, with peak levels not typically monitored in clinical practice, as recommended by the Infectious Diseases Society of America 1.

Importance of Trough Levels

Trough levels are crucial in monitoring the effectiveness of vancomycin and minimizing the risk of toxicity.

• Trough levels measure the lowest concentration of vancomycin in the blood, typically drawn just before the next scheduled dose.
• Target trough levels vary depending on the infection being treated, but for serious infections like endocarditis, meningitis, or MRSA pneumonia, higher trough levels of 15-20 mcg/mL are recommended 1.

Monitoring and Dosage Adjustments

Monitoring of trough levels is essential to optimize efficacy and minimize toxicity.

• Trough levels should be obtained at steady-state conditions, prior to the fourth or fifth dose 1.
• Dosage adjustments should be made based on trough levels to achieve target concentrations and minimize the risk of nephrotoxicity and ototoxicity.

Clinical Practice Guidelines

Clinical practice guidelines recommend monitoring trough levels and adjusting dosages accordingly.

• The Infectious Diseases Society of America recommends trough concentrations of 15-20 mcg/mL for serious infections due to MRSA 1.
• The American Society of Health-System Pharmacists and the Society of Infectious Diseases Pharmacists also recommend monitoring trough levels and adjusting dosages to achieve target concentrations 1.

From the Research

Vancomycin Therapeutic Drug Monitoring

• Therapeutic drug monitoring (TDM) of vancomycin is crucial to ensure its effectiveness and minimize toxicity 2
• The goal of TDM is to maintain vancomycin trough concentrations between 15-20 mg/L for most infections 2
• However, the concept of "pick and truf" is not directly related to vancomycin TDM

Definition of Pick and Truf

• There is no clear definition of "pick and truf" in the context of vancomycin or antimicrobial therapy 2, 3, 4, 5, 6
• It is possible that "pick and truf" refers to a specific dosing strategy or monitoring approach, but this is not supported by the available evidence

Vancomycin Dosing and Monitoring

• Vancomycin dosing and monitoring are critical to ensure effective treatment and minimize toxicity 2
• The dosage and administration of vancomycin should be individualized based on patient factors, such as renal function and infection severity 2
• TDM is essential to ensure that vancomycin concentrations remain within the therapeutic range and to minimize the risk of toxicity 2

Limitations of Current Evidence

• The current evidence does not provide a clear definition or explanation of "pick and truf" in the context of vancomycin therapy 2, 3, 4, 5, 6
• Further research is needed to clarify the meaning and significance of "pick and truf" in antimicrobial therapy