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• W2896900118 abstract "ABSTRACT The common practice of adjusting vancomycin dosage based on peak and trough serum levels is examined. To justify the routine monitoring of serum levels of any drug, it must have predictable pharmacokinetics; there must be a correlation between serum levels and effect; and the drug must have a narrow therapeutic index. Peak vancomycin levels are difficult to predict due to the drug's highly variable distribution phase half-life. Since troughs are drawn after distribution is complete, they are readily predictable. Vancomycin's ototoxic potential is doubtful and the incidence of nephrotoxicity is low in patients not receiving concomitant nephrotoxic drugs. There are several studies suggesting that vancomycin may potentiate the nephrotoxicity of other drugs. Trough vancomycin levels greater than 1O mg/L have been correlated to nephrotoxicity; there is no evidence correlating peak levels to ototoxicity or nephrotoxicity. Information relating the efficacy of vancomycin to serum levels is not available. However, based on the minimum inhibitory concentrations for susceptible bacteria and vancomycin's concentration independent killing properties, trough levels between 5 and 10 mg/L would appear adequate. This information suggests that routine monitoring of trough, but not peak, vancomycin serum levels is justified. Initial vancomycin doses should be calculated using available nomograms. Trough vancomycin levels should be maintained between 5 and 10 mg/L by use of dosing nomograms or empiric adjustment. RESUME On a evalue la pratique courante selon laquelle on ajuste la dose de vancomycine selon les concentrations plasmatiques maximales et minimales. Le dosage plasmatique regulier de tout medicament n'est justifie que si sa pharmacocinetique est previsible; s'il existe une correlation entre les concentrations seriques et les effets observes; et si le medicament a une zone therapeutique etroite. Il est difficile de prevoir les pics plasmatiques de la vancomycine parce que sa distribution et sa demi-vie sont grandement variables. Comme les creux plasmatiques sont preleves apres que la vancomycine soit completement distribuee, ils sont donc facilement previsibles. Le risque d'ototoxicite de la vancomycine est discutable et la frequence de nephrotoxicite est faible chez les patients qui ne recoivent pas concurremment d'autres medicaments nephrotoxiques. Les resultats de nombreuses etudes ont laisse croire que la vancomycine pouvait accroitre le potentiel nephrotoxique d'autres medicaments. On a associe la nephrotoxicite a des concentrations plasmatiques minimales superieures a 10 mg/L; on n'a cependant obtenu aucune preuve de correlation entre l'ototoxicite ou la nephrotoxicite et des concentrations plasmatiques maximales. On ne dispose non plus d'aucune information sur le lien entre les concentrations plasmatiques de la vancomycine et l'efficacite de ce medicament. Cependant, en se basant sur les concentrations minimales inhibitrices de la vancomycine pour les bacteries qui y sont sensibles et sur son pouvoir bactericide independant des concentrations, des concentrations minimales entre 5 et 10 mg/L semblent etre suffisantes. Cette information porte a croire que la mesure systematique des concentrations plasmatiques minimales de la vancomycine, et non celle des concentrations maximales, est justifiee. Les doses initiales de vancomycine devraient etre etablies en utilisant les nomogrammes disponibles. Les concentrations minimales devraient etre maintenues entre 5 et 10 mg/L en ayant recours aux nomogrammes ou a l'ajustement empirique de la dose." @default.
• W2896900118 created "2018-10-26" @default.
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• W2896900118 date "1995-02-26" @default.
• W2896900118 modified "2023-09-26" @default.
• W2896900118 title "Rationalization of Vancomycin Serum Concentration Monitoring" @default.
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• W2896900118 doi "https://doi.org/10.4212/cjhp.v48i1.2240" @default.
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