From the Research
No, vancomycin trough levels are not typically ordered when administering vancomycin via a PEG tube. Trough monitoring is standard practice for intravenous vancomycin administration but not for oral or enteral vancomycin. When given via a PEG tube, vancomycin has minimal systemic absorption from the gastrointestinal tract, with less than 5% reaching the bloodstream 1. The medication primarily stays within the gut lumen where it acts locally to treat conditions like Clostridioides difficile infections. Because of this poor systemic absorption, blood levels remain very low regardless of the dose administered, making trough monitoring unnecessary and uninformative. If systemic vancomycin therapy is needed, the intravenous route should be used instead, which would then require appropriate trough monitoring to ensure therapeutic levels while avoiding toxicity, as suggested by studies on vancomycin dosing and monitoring 2, 3, 4. When administering vancomycin through a PEG tube, focus instead on ensuring proper medication administration techniques, such as flushing the tube before and after medication delivery to prevent clogging. It's also worth noting that the current guidelines and practices for vancomycin monitoring, including the use of trough concentrations, have been subject to review and debate in the medical community, with some studies suggesting that AUC/MIC dosing may be a more effective approach to minimizing the risk of acute kidney injury 4. However, these considerations are more relevant to intravenous vancomycin administration rather than enteral administration via a PEG tube. Given the context of the question, the key point remains that trough monitoring is not typically necessary for vancomycin administered via a PEG tube due to its minimal systemic absorption.