From the Guidelines
The normal trough level for vancomycin is 15-20 mg/L.
Vancomycin Trough Levels
- For serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe skin and soft tissue infections (SSTI) due to methicillin-resistant Staphylococcus aureus (MRSA), trough vancomycin concentrations of 15-20 mg/L are recommended 1, 2.
- These target trough concentrations are based on the pharmacodynamic parameter of the area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio (AUC/MIC), which is the best predictor of vancomycin efficacy 1.
- Trough monitoring is recommended for patients with serious infections, morbid obesity, renal dysfunction, or fluctuating volumes of distribution 1.
- Vancomycin doses of 15-20 mg/kg/day every 8-12 hours are recommended for adult patients, with adjustments based on estimated creatinine clearance and actual body weight 1.
- A vancomycin loading dose of 25 mg/kg may be considered for serious suspected or documented MRSA infections, although clinical data are limited 1.
From the FDA Drug Label
In subjects with normal kidney function, multiple intravenous dosing of 1 g of vancomycin (15 mg/kg) infused over 60 minutes produces mean plasma concentrations of approximately 63 mcg/mL immediately after the completion of infusion, mean plasma concentrations of approximately 23 mcg/mL 2 hours after infusion, and mean plasma concentrations of approximately 8 mcg/mL 11 hours after the end of the infusion.
The normal trough level for vancomycin is approximately 10-20 mcg/mL for patients with normal renal function, although the exact trough level is not explicitly stated in the provided drug labels [3] [4].
- Key points: + Trough levels are typically measured just before the next dose. + The provided drug labels do not explicitly state the normal trough level for vancomycin. + However, based on the pharmacokinetic data, trough levels can be estimated to be around 10-20 mcg/mL for patients with normal renal function.
From the Research
Vancomycin Trough Levels
- The normal trough level for vancomycin is a topic of debate, with various studies suggesting different target concentrations 5, 6, 7, 8, 9.
- According to some studies, a trough concentration of 15-20 mg/L is recommended for complicated infections 6, 7, 9.
- However, other studies suggest that a trough concentration of <15 mg/L may be adequate for some adults, and that targeting higher trough concentrations may increase the risk of nephrotoxicity 5, 6.
- The Infectious Diseases Society of America clinical practice guideline recommends achieving a trough concentration of 15-20 mg/L for complicated infections 7.
- A study published in 1994 suggested that peak vancomycin concentrations do not need to be measured as long as trough concentrations do not exceed 15 mg/L 8.
- Another study published in 2013 proposed a new AUC-based dosing chart for vancomycin, which estimates the daily dose based on creatinine clearance, vancomycin clearance, and the desired AUC24/MIC 9.
Target Trough Concentrations
- 15-20 mg/L: recommended for complicated infections 6, 7, 9
- <15 mg/L: may be adequate for some adults, but may increase the risk of nephrotoxicity if targeted 5, 6
- 10-15 mg/L: moderate dose, proposed in the AUC-based dosing chart 9