Antimicrobial drugs normally have a high therapeutic index with supratherapeutic doses given safely (e.g. penicillins, macrolides, sulphonamides). The situation is different for aminoglycosides and some glycopeptides, which may cause significant toxicity just above the concentration required for bactericidal activity.
Vancomycin is a glycopeptide active only against aerobic and anaerobic Gram-positive organisms. It is given intravenously in the prophylaxis and treatment of endocarditis and other serious infections caused by Gram-positive cocci including multi-resistant Staphylococcus aureus (MRSA). As with the aminoglycosides, nephrotoxicity and ototoxicity may occur at plasma concentrations above the therapeutic range. The risks are enhanced if aminoglycosides are given at the same time. The most common adverse reaction, flushing of the upper body (‘red man’ syndrome) occurs if the drug is infused too rapidly or too high a plasma concentration is attained. Toxicity is related to higher levels with this agent and again, it is the pre-dose level which should be monitored. Pre-doses are more reliable to monitor, as vancomycin has to be infused over at least an hour, causing post-dose levels to be more variable. Therefore post-dose vancomycin levels are not tested.
Take sample pre-dose (trough, at least 15 min before dose)
Pre dose samples only. First sample around 2nd - 4th dose.
Interval for re-assay is usually 3 days
From 1st April 2016, please use Chemistry and Immunology request forms.
Please complete request forms with time of dosing and sampling.
Pre dose (trough) level 10- 15 mg/L.
For more information please see pharmacy guidance (http://pharmacy/?page_id=922)
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The Trust Laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital were awarded UKAS (United Kingdom Accreditation Service) accreditation to the internationally recognised ISO 15189 standard in May 2015. For a list of accredited tests and other information please visit the test database http://www.heftpathology.com/frontpage/test-database.html.
Tests not appearing on this scope are either under consideration or in the process of accreditation and so currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.
For further information contact Louise Fallon, Quality Manager, 0121 424 1235