Specimen Collection

Sample collection times:

Random Concentration for Area Under the Curve (AUC) monitoring	Preferred	Within 24 hours after loading dose or dose change (at least 1 hour after the end of the infusion) Record time the blood was taken
Trough	For neonates or if AUC monitoring not available	30 minutes before next dose

Adults

When using the Vanculator dosing and monitoring guide:

• After loading dose - Trough level: within one hour before next dose.
• Maintenance dose - Trough level: one hour before the fourth maintenance dose is given.
• After changing vancomycin dose - Trough level: one hour before the fourth dose following the change in dose.

Paediatrics

• Check a trough level before the 4th dose and then every 3 (-5) days if the level is satisfactory and renal function normal.
  

Samples >2hrs please refrigerate and transport, >48hrs please freeze samples and transport.

Sample stability:

• 48 hours at 15-25 ^o C
• 14 days at 2-8 ^o C
• 12 months at -20 ^o C

4.5 mL PST Blood (Preferred)

0.5 mL Paediatric Micro-PST Blood (Preferred)

4 mL EDTA Blood

5 mL Heparin Blood

4 mL Plain Blood

3.5 mL SST Blood

0.5 mL Paediatric Microsample Serum

0.6 mL Paediatric Micro-heparin Blood

0.5 mL Paediatric Micro-SST Serum
Reference Intervals

Units: mg/L

Recommended concentrations

AUC monitoring (except NICU): contact clinical pharmacist to perform AUC calculations and advise on next dose.

Trough monitoring:

	Adults	Children	Neonates
Trough	15-20 mg/L	10-20 mg/L	10-20 mg/L

Continuous infusion monitoring: 17-25 mg/mL

Therapeutic intervals:

Adults: Target trough level for intermittent dosing regime	15 - 20
Paediatric population: For target trough levels in haematology-oncology paediatric patients - refer to https://starship.org.nz/guidelines/vancomycin-for-child-cancer/ For other (non-haematology/oncology) paediatric patients refer to general Dosage and Monitoring Guideline at https://starship.org.nz/guidelines/vancomycin
Target steady state level for 24 hour continuous infusion regimen (more commonly used in outpatient parenteral antibiotic therapy setting)	20 - 25

Uncertainty of Measurement: 1.5 mg/L at a level of 6 mg/L

12% at a level of 16 mg/L and higher

Turnaround Time: Within 3 hours
Assay Method

Principle: Immunoturbidometric assay

Reagents: Roche TDM Vancomycine Gen. 3

Analyser: Cobas c502

Diagnostic Use and Interpretation

Adults

Since February 2013 a new vancomycin dosing and monitoring guideline has been in use. The " vanculator " should be used to calculate loading dose and initial maintenance dose of vancomycin in all adult patients.

See the Intranet for Vanculator (located under V).

For vancomycin trough levels outside the above target range, please contact the on call adult infectious disease registrar or physician for advice regarding possible vancomycin dose adjustment.

Paediatrics

Refer to the Starship intranet - Vancomycin guideline - for dosing and monitoring regimen.

For target trough levels in haematology-oncology paediatric patients - refer to https://starship.org.nz/guidelines/vancomycin-for-child-cancer/

For other (non-haematology/oncology) paediatric patients refer to general Dosage and Monitoring Guideline at https://starship.org.nz/guidelines/vancomycin

General

• Checking peak levels for vancomycin is unnecessary . It does not add value to clinical management and this practice should be abandoned.

• The relationship between vancomycin and nephrotoxicity is not clear. However, it may contribute to nephrotoxicity when administered with other nephrotoxic agents such as aminoglycosides and amphotericin.

References

1. Hidayat LK et al. High dose vancomycin therapy for MRSA: efficacy and toxicity. Arch Intern Med 2006; 166:2138-44
   
2. Ingram PR et al Risk factors for nephrotoxicity associated with continuous vancomycin infusion in outpatient parenteral antibiotic therapy. Journal of Antimicrobial Chemotherapy 2008: 62: 168-171
3. Rybak MJ et al. Vancomycin therapeutic guidelines: A summary of consensus recommendations from the Infectious diseases society of America, the American Society of Health-system pharmacists and the Society of Infectious diseases pharmacists. Clinical Infectious diseases 2009; 49:325-7
4. Vandeasteele SJ, De Vriese AS, Tacconelli E. The pharmacokinetics and pharmacodynamics of vancomycin in clinical practice: evidence and uncertainties. J Antimicrob Chemother 2013; 68: 743-748
   

Contact Information

For any analytical inquires, contact the Chemistry Department via LabLink or a Chemical Pathologist:

Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402

Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052

Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427

Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427

Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427

For any clinical and dosage inquires, contact either the antimicrobial stewardship pharmacist, the Microbiology Department via LabLink or a Clinical Microbiologist:

Dr Sally Roberts , Microbiologist: ext 22705 Cellphone 021 674 140
Dr Sharmini Muttaiyah , Microbiologist: ext 22700 Cellphone 021 615 892
Dr Mary de Almeida , Microbiologist: ext 22700 Cellphone 021 170 9117

Dr Matthew Blakiston , Microbiologist: contact via Lablink

Last updated at 08:32:02 01/04/2025