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Test ID: VANTA    
Vancomycin, Trough, Serum

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Useful For Suggests clinical disorders or settings where the test may be helpful

Preferred test for monitoring vancomycin therapy

 

Monitoring trough concentrations drawn at steady-state in selected patients receiving vancomycin therapy

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Vancomycin is an antibiotic used to treat infections caused by gram-positive organisms that are resistant to beta-lactam antibiotics, such as methicillin-resistant staphylococci (MRSA), Streptococcus viridans group, penicillin/cephalosporin-resistant Streptococcus pneumoniae, and penicillin/ampicillin-resistant Enterococcus species.

 

The oral formulation, which is not absorbed, is used in the treatment of pseudomembranous colitis caused by Clostridium difficile. Vancomycin is also used when patients are intolerant or allergic to beta-lactam antibiotics.

 

Vancomycin has been associated with nephrotoxicity and ototoxicity, although it appears that many of these reports reflected impurities in early formulations. Monitoring of vancomycin-related nephrotoxicity is recommended only for patients with reduced renal function, those receiving aggressive or prolonged vancomycin regimens, or those at high-risk including patients comedicated with other nephrotoxic agents.

 

Trough concentrations are recommended for therapeutic monitoring of vancomycin, preferably acquired at steady-state (just before fourth dose). To avoid development of resistance, vancomycin trough levels should remain above 10.0 mcg/mL. Complicated infections require higher target levels, typically 15.0 to 20.0 mcg/mL. Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic analyses (eg, area under the curve: AUC studies) or for select patients.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Therapeutic: 10.0-20.0 mcg/mL

Interpretation Provides information to assist in interpretation of the test results

Trough levels correlate better with efficacy than peak levels, with target trough levels of 10.0 to 20.0 mcg/mL, depending on the type of infection.

 

These levels are consistent with Mayo Clinic Antimicrobial Therapy Guidelines.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

As with any assay employing mouse antibodies, the possibility exists for interference by human antimouse antibodies (HAMA) in the sample, which could cause falsely lowered results.

 

Unspecific binding of heterophilic antibodies from the sample to glucose-6-phosphate dehydrogenase of the reagent may lead to falsely lower test results in very rare cases (<10[-6]).

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic drug 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;66:82-98

2. Estes L, Wilson J: Mayo Clinic Antimicrobial Therapy Quick Guide. Mayo Clinic. 2005. Updated July 29, 2020