Safe and effective use of vancomycin

Vancomycin is an important antimicrobial for prophylactic, empirical and directed therapy of Gram-positive organisms. Therapeutic drug monitoring is recommended for all patients expected to receive vancomycin for more than 48 hours to optimise drug exposure. Monitoring the area under the concentration–time curve over a 24-hour period (AUC₂₄) for vancomycin is preferred over monitoring trough plasma concentrations. An AUC₂₄ of 400 to 600 mg.hr/L is recommended for infections other than central nervous system infections. Vancomycin may cause nephrotoxicity, ototoxicity, cutaneous reactions, hypersensitivity and haematological toxicity. Reducing the incidence of vancomycin-induced nephrotoxicity involves recognising and modifying risk factors where possible.