Changes to Vancomycin Trough Concentration Reference Range, February 2009
Beginning February 5, 2009, the trough level reference range for vancomycin was changed from 5-15 mg/L to 10-20 mg/L.
This change was made in accordance with recent guidelines. The guidelines recommend the shift in the recommended therapeutic trough range in order to maximize attainment of the pharmacodynamic target, increase penetration to the site of infection, and minimize/prevent the development of resistance. Overall, the recommendation is to always maintain a trough above 10 mg/L to prevent the development of resistance. For more deep-seated infections (e.g., pneumonia, osteomyelitis, endocarditis, meningitis), the data supporting a clear benefit of higher troughs are lacking, and there is accumulating evidence that increased nephrotoxicity may result, although many confounding factors exist.
Please contact Elizabeth Hermsen, Pharm.D., M.B.A., BCPS-ID at 559-4287 or firstname.lastname@example.org with any questions.
 Rybak M, et al. 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. Am J Health-Syst Pharm. 2009;66-82-98.