At a Glance
Why Get Tested?
When to Get Tested?
Test Preparation Needed?
The Test Sample
What is being tested?
It is important to monitor the level of vancomycin because its effectiveness depends on sustaining blood levels at a minimum concentration for the duration of therapy. Furthermore, excessive concentrations of vancomycin must be avoided because high levels can result in serious side effects, specifically damage to hearing (ototoxicity) and kidney damage (nephrotoxicity). The amount of vancomycin given per dose depends on a variety of factors, including kidney function, other nephrotoxic drugs the person may be taking, age, and weight.
Someone with decreased kidney function may not be able to clear the drug out of his system efficiently, resulting in increased concentration in the blood. If a person is given too little drug and is unable to maintain a sufficient minimum dose in the blood, then it is unlikely that treatment will be effective. The vancomycin test can be used to monitor the amount of drug in the blood to ensure that it remains at a therapeutic concentration – adequate but not excessive.
Vancomycin is given by injection into a vein (intravenous) to treat infections such as septicemia, endocarditis, infection of the bone (osteomyelitis), some pneumonias, and meningitis. It is often the drug of choice for methicillin-resistant Staphylococcus epidermidis and Staphylococcus aureus infections, especially when they are associated with implanted prosthetic devices such as heart valves, artificial hips, and indwelling catheters. Vancomycin may also be given to prevent an infection (prophylactically) to some people before specific surgeries and dental procedures. Intravenous vancomycin administration is necessary to get the drug into circulation because oral vancomycin is poorly absorbed. Oral vancomycin is prescribed to treat some resistant Clostridium difficile infections, infections that occur in the gastrointestinal tract where absorption into the circulation is not needed.
How is the sample collected for testing?
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
(Reviewed 2008 September 1). Vancomycin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604038.html. Accessed April 2010.
Goodman, A. (2009 November 5). New Highly Virulent Strain of Vancomycin-Resistant MRSA Carries High Mortality Rate. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/711869 through http://www.medscape.com. Accessed April 2010.
(Updated 2010 March 1). Vancomycin (Intravenous Route, Injection Route). MayoClinic.com. [On-line information]. Available online at http://www.mayoclinic.com/health/drug-information/DR601965 through http://www.mayoclinic.com. Accessed April 2010.
Levison, M. (Revised 2009 July). Vancomycin. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch170/ch170q.html#sec14-ch170-ch170p-432 through http://www.merck.com. Accessed April 2010.
Check, W. (2009 July). Vancomycin targets—tactics for tough foe. CAP Today. [On-line information]. Available online through http://www.cap.org. Accessed April 2010.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 1508-1509.
Vancomycin Therapeutic Monitoring: Review and Recommendations from the ASHP, IDSA and SIDP Task Force. Am J Health-Syst Pharm. 2009; 66:82-98. Available online at http://www.ajhp.org/cgi/content/full/66/1/82 through http://www.ajhp.org. Accessed July 2010.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Phend, C. (2005 September 27). Vancomycin Monitoring Uncommon for Pediatric Patients: Presented at ACCP. Doctor's Guide [On-line information]. Available online at http://www.pslgroup.com/dg/2533B6.htm through http://www.pslgroup.com.
Briceland, L. (2005 October 20). Vancomycin Trough Levels. Medscape, Ask the Experts about Pharmacotherapy [On-line information]. Available online at http://www.medscape.com/viewarticle/514670 through http://www.medscape.com.
Briceland, L. (2005 October 13). Vancomycin Duration of Treatment. Medscape, Ask the Experts about Pharmacotherapy [On-line information]. Available online at http://www.medscape.com/viewarticle/514363 through http://www.medscape.com.
(© 2003). Vancomycin (Vancocin ®), Serum, Peak. Labcorp [On-line information]. Available online at http://www.labcorp.com/datasets/labcorp/html/chapter/mono/td024700.htm through http://www.labcorp.com.
(1999 June 15). Vancomycin (Systemic). MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/drug-information/DR202590 through http://www.mayoclinic.com.
Darko, W. et. al. (2003 June 17). Mississippi Mud No More: Cost-Effectiveness of Pharmacokinetic Dosage Adjustment of Vancomycin to Prevent Nephrotoxicity. Medscape from Pharmacotherapy 23(5):643-650 [On-line information]. Available online at http://www.medscape.com/viewarticle/455754 through http://www.medscape.com.
Middlebrooks, M. (2003 September 22, Revised). Vancomycin Monitoring Protocol. LSU Health Sciences Center, Shreveport Department of Pharmacy Services [On-line information]. Available online through http://www.sh.lsuhsc.edu.
(2006 April, Updated). Laboratory Detection of Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA) [On-line information]. Available online at http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_labFAQ.html through http://www.cdc.gov.
Marraffa, J. et. al. (2003 October 14). Vancomycin-Induced Thrombocytopenia: A Case Proven With Rechallenge. Medscape from Pharmacotherapy 23(9): 1195-1198 [On-line information]. Available online at http://www.medscape.com/viewarticle/461407 through http://www.medscape.com/.
Fraser, T. et. al. (2005 October 11). Vancomycin and Home Health Care. Medscape, from Emerg Infect Dis [On-line information]. Available online at http://www.medscape.com/viewarticle/513521 through http://www.medscape.com/.
(1999 June 15, Revised). Vancomycin (Systemic). MedlinePlus Drug Information [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202590.html.
Keyserling, H. et. al. (2003). Vancomycin use in hospitalized pediatric patients. Medscape from Pediatrics 112(2): e104-11 [On-line information]. Available online at http://www.medscape.com/medline/abstract/12897315?queryText=vancomycin through http://www.medscape.com/.
James, C. and Gurk-Turner, C. (2001 April). Recommendations for monitoring serum Vancomycin concentrations. Baylor University Medial Center Proceedings 14:189-190 [On-line information]. Available online at http://www.baylorhealth.edu/proceedings/14_2/14_2_gurk-turner.html through http://www.baylorhealth.edu.