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Vancomycin, Trough (VANCT)

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EPIC Test Name

VANCOMYCIN, TROUGH

EPIC Code

LAB39

Specimen Requirements

plasma
Minimum Volume:0.5 mL
Collection:Collect using standard laboratory procedures
Transport:Room Temperature ASAP
Stability:Room Temperature: 48 hours at 15-25 degrees C capped
Refrigerated: 14 days at 2-8 degrees C capped
Frozen: 12 months at -15 to -25 degrees C capped
Container:LT GRN
Processing/Storage:Centrifuge, pour off, and refrigerate plasma.
Rejection Causes:Hemolysis,
Insufficient Sample Volume, lipemic samples
Notes:Trough level should be drawn 30 minutes prior to next dose.

Methods

Kinetic Interaction of Microparticles in a Solution (KIMS)

Turnaround Time

SpecimenTurnaround TimeFrequency
plasmaStat: 90 minutes Routine: 4 hours24/7

Reference Ranges

Kinetic Interaction of Microparticles in a Solution (KIMS)
UnitCritical ValuesTherapeutic Levels
µg/mL>20.0 ug/mL10-20 µg/mL

Clinical Indications

Vancomycin is a glycopeptide having bactericidal effect for treating infection of gram-positive bacteria and some gram-negative cocci. Vancomycin is commonly used for methicillin-resistant staphylococci (MRSA) and corynebacteria infection, e.g., endocarditis and sepsis caused by these organisms.
Vancomycin is generally poorly absorbed via oral administration. Its oral formulation is used in the treatment of pseudomembranous colitis caused by Clostridium difficile. Vancomycin is usually given intravenously to patients with normal renal function. A dose of 1 gram, IV, every 12 hours usually results in a peak blood concentration of 20-40 µg/mL (14 to 28 µmol/L) and a trough concentration of 5-10 µg/mL (4 to 7 µmol/L). Its average elimination half-life is 5-6 hours. Its toxicity mainly involves nephrotoxicity. Other side effects or toxicities regardless dose or blood concentrations may include fever, phlebitis, and pain at the infusion site. A “red man syndrome” or “red neck syndrome” characterized with erythema or flushing of the face, neck, and upper torso may occur in about 5 to 10 minutes after IV infusion. Such a syndrome is believed to be due to acute, non–IgE-mediated mast cell degranulation and is generally managed by slow infusion and administration of antihistamines.
Monitoring of vancomycin concentration is recommended for patients with reduced renal function, under aggressive or prolonged vancomycin treatment regimens, or patients at high risk of nephrotoxicity (e.g., patients receiving concurrent nephrotoxins).
Trough concentrations are as recommended by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. The recommendation also include:
• Minimum serum vancomycin trough concentrations should always be maintained above 10 mg/L to avoid development of resistance. For a pathogen with an MIC of 1 mg/L, the minimum trough concentration would have to be at least 15 mg/L to generate the target AUC:MIC of 400;
• Vancomycin-Induced Nephrotoxicity is defined as a minimum of two or three consecutive documented increases in serum creatinine concentrations (defined as an increase of 0.5 mg/dL or a =50% increase from baseline, whichever is greater) after several days of vancomycin therapy.
• Frequent monitoring (more than one trough before the fourth dose) ) is not recommended for short course or lower intensity dosing (to attain target trough concentrations below 15 mg/L.
• Patients on prolonged courses of vancomycin (exceeding three to five days) should have at least one steady-state trough concentration obtained no earlier than at steady state (just before the fourth dose) and then repeated as deemed clinically appropriate.
• Additional recommendation can be found at Am J Health Syst Pharm. 2009;66(1):82-98.
For obtaining Trough concentrations, samples should be obtained just prior to the next dose at steady-state conditions (just before the fourth dose).

Performed

Lab
Chemistry - Community
Chemistry - Downtown

Interpretative Information

For patients receiving aggressive dosing, to achieve sustained trough levels of 15–20 mg/L is recommended, depending on the pathogens of infection.

CPT

80202

LOINC

4092-3

References

1. CM Thompson Jr, Long SS, PH Gilligan, et al.: Absorption of oral vancomycin: possible associated toxicity. Int J Pediatr Nephrol. 4:1-4 1983 6853034
2. Geraci JE. Vancomycin. Mayo Clin Proc. 1977 Oct;52(10):631-4. PMID: 909314.
3. Rybak M, Lomaestro B, Rotschafer JC, Moellering R Jr, Craig W, Billeter M, Dalovisio JR, Levine DP. 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(1):82-98. doi: 10.2146/ajhp080434. Erratum in: Am J Health Syst Pharm. 2009 May 15;66(10):887. PMID: 19106348.
4. Saunders NJ. Why monitor peak vancomycin concentrations? Lancet. 1994;344:1748-50.

Contact Information

Chemistry - Downtown: (315)464-4460
Chemistry - Community: (315)492-5531
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