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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.[1] 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 ehermsen@nebraskamed.com with any questions.

[1] 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.

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