Vancomycin therapeutic drug monitoring: is it necessary?
OBJECTIVE
To review the literature and assess the validity of obtaining vancomycin serum drug concentrations in patients.


METHODS
A MEDLINE search of the English literature and a bibliographic review of articles pertaining to vancomycin serum concentrations, their use, and the rationale of cited therapeutic ranges.


METHODS
Studies pertaining to the use of vancomycin concentrations in the clinical setting, methods for predicting these concentrations, and studies that reported efficacy or toxicity associated with vancomycin use and possible correlation of serum concentrations.


RESULTS
The usefulness of vancomycin serum concentrations, the determination of a therapeutic range of values, and their correlation to antibacterial efficacy and drug toxicity in the clinical setting are controversial. Old reports of toxicities need to be critically examined due to lack of information and the actual frequency of toxic reactions. The efficacy of vancomycin's antibacterial effect and its correlation with reported therapeutic ranges may advocate obtaining a vancomycin trough concentration in certain groups of patients.


CONCLUSIONS
Determination of serum vancomycin concentrations in the clinical setting and their usefulness in patient care is questionable and unnecessary in the majority of patients.
Freeman
C D
CD
Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Weatherford 73096.
Quintiliani
R
R
Nightingale
C H
CH
D000818:Animals; D001424:Bacterial Infections / Q000188:drug therapy*; D002675:Child, Preschool; D016903:Drug Monitoring; D004427:Ear Diseases / Q000139:chemically induced; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000139:chemically induced; D014640:Vancomycin / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use
D014640:Vancomycin