Editing Vancomycin (section)

==Therapeutic drug monitoring==
Plasma level monitoring of vancomycin is necessary due to the drug's biexponential distribution, intermediate hydrophilicity, and potential for ototoxicity and nephrotoxicity, especially in populations with poor renal function and/or increased propensity to bacterial infection. Vancomycin activity is considered time-dependent; that is, antimicrobial activity depends on how long the serum drug concentration exceeds the [[minimum inhibitory concentration]] <!-- (MIC) --> of the target organism. Thus, peak serum levels have not been shown to correlate with efficacy or toxicity; indeed, concentration monitoring is unnecessary in most cases. Circumstances in which [[therapeutic drug monitoring]] <!-- (TDM) --> is warranted include patients receiving concomitant aminoglycoside therapy, patients with (potentially) altered [[pharmacokinetics|pharmacokinetic]] parameters, patients on [[hemodialysis|haemodialysis]], patients administered high-dose or prolonged treatment, and patients with impaired renal function. In such cases, trough concentrations are measured.<ref name="AMH2006" /><ref name="pmid8038306">{{cite journal | vauthors = Cantú TG, Yamanaka-Yuen NA, Lietman PS | title = Serum vancomycin concentrations: reappraisal of their clinical value | journal = Clinical Infectious Diseases | volume = 18 | issue = 4 | pages = 533–43 | date = April 1994 | pmid = 8038306 | doi = 10.1093/clinids/18.4.533 }}</ref><ref name="pmid8038307">{{cite journal | vauthors = Moellering RC | title = Monitoring serum vancomycin levels: climbing the mountain because it is there? | journal = Clinical Infectious Diseases | volume = 18 | issue = 4 | pages = 544–6 | date = April 1994 | pmid = 8038307 | doi = 10.1093/clinids/18.4.544 }}</ref><ref name="Karam1999">{{cite journal | vauthors = Karam CM, McKinnon PS, Neuhauser MM, Rybak MJ | s2cid = 24947921 | title = Outcome assessment of minimizing vancomycin monitoring and dosing adjustments | journal = Pharmacotherapy | volume = 19 | issue = 3 | pages = 257–66 | date = March 1999 | pmid = 10221365 | doi = 10.1592/phco.19.4.257.30933 }}</ref>

Therapeutic drug monitoring is also used for dose optimization of vancomycin in treating children.<ref name="pmid38325652"/>

Target ranges for serum vancomycin concentrations have changed over the years. Early authors suggested peak levels of 30 to 40&nbsp;mg/L and [[trough levels]] of 5 to 10&nbsp;mg/L,<ref name="pmid909314">{{cite journal | vauthors = Geraci JE | title = Vancomycin | journal = Mayo Clinic Proceedings | volume = 52 | issue = 10 | pages = 631–4 | date = October 1977 | pmid = 909314 }}</ref> but current recommendations are that peak levels need not be measured and that [[trough levels]] of 10 to 15&nbsp;mg/L or 15 to 20&nbsp;mg/L, depending on the nature of the infection and the specific patient's needs, may be appropriate.<ref name="pmid19106348">{{cite journal | vauthors = Rybak M, Lomaestro B, Rotschafer JC, Moellering R, Craig W, Billeter M, Dalovisio JR, Levine DP | title = 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 | journal = American Journal of Health-System Pharmacy | volume = 66 | issue = 1 | pages = 82–98 | date = January 2009 | pmid = 19106348 | doi = 10.2146/ajhp080434 | s2cid = 11692065 | citeseerx = 10.1.1.173.737 }}</ref><ref name="pmid19299472">{{cite journal | vauthors = Thomson AH, Staatz CE, Tobin CM, Gall M, Lovering AM | title = Development and evaluation of vancomycin dosage guidelines designed to achieve new target concentrations | journal = The Journal of Antimicrobial Chemotherapy | volume = 63 | issue = 5 | pages = 1050–7 | date = May 2009 | pmid = 19299472 | doi = 10.1093/jac/dkp085 | url = http://strathprints.strath.ac.uk/13001/ | doi-access = free | access-date = 15 September 2017 | archive-date = 15 September 2017 | archive-url = https://web.archive.org/web/20170915161446/http://strathprints.strath.ac.uk/13001/ | url-status = live }}</ref> Measuring vancomycin concentrations to calculate doses optimizes therapy in patients with [[augmented renal clearance]].<ref name="pmid31534058">{{cite journal | vauthors = Izumisawa T, Kaneko T, Soma M, Imai M, Wakui N, Hasegawa H, Horino T, Takahashi N | title = Augmented Renal Clearance of Vancomycin in Hematologic Malignancy Patients | journal = Biological & Pharmaceutical Bulletin | volume = 42 | issue = 12 | pages = 2089–2094 | date = December 2019 | pmid = 31534058 | doi = 10.1248/bpb.b19-00652 | doi-access = free }}</ref>