At a Glance
Why Get Tested?
To measure and monitor the level of vancomycin in your blood
When to Get Tested?
At intervals during vancomycin treatment
A blood sample drawn from a vein in your arm
Test Preparation Needed?
None, but timing of the sample for testing is important; follow any instructions provided.
The Test Sample
What is being tested?
Vancomycin is an antimicrobial drug that is used to treat serious infections caused by Gram-positive bacteria. Developed in the 1950s, vancomycin was originally prescribed primarily when organisms proved resistant to penicillin or when a person was allergic to penicillin. Its use declined with the introduction of other antimicrobials such as methicillin but has risen again with the emergence of certain strains of Staphylococcus, such as methicillin-resistant Staphylococcus aureus (MRSA). This test measures the concentration of vancomycin in the blood.
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.
Decreased kidney function may prevent efficient clearance of vancomycin from a person's system, 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 – that is, adequate but not excessive.
Vancomycin is given intravenously (by injection into a vein) 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 MRSA 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 some people before specific surgeries and dental procedures to prevent an infection. 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. These occur in the gastrointestinal tract, where absorption into the circulating blood is not needed. Vancomycin is also used for patients who are intolerant or allergic to beta-lactams.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm.
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?
No test preparation is needed, but the timing of the sample for testing is important. Follow instructions provided for collection and tell the laboratorian when the administration of the last intravenous dose was completed.
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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.
Sources Used in Current Review
Swee Leong Yap, MBBS; Chief Editor: Eric B Staros, MD. Vancomycin Level. Medscape. Available online at http://emedicine.medscape.com/article/2090484-overview through http://emedicine.medscape.com. Last updated March 16, 2012. Accessed February 4, 2014.
Ben M Lomaestro. Medscape Multispecialty. Available online at http://www.medscape.com/viewarticle/747418_15 through http://www.medscape.com. Expert Rev Anti Infect Ther. 2011;9(6):657-667. Accessed February 4, 2014.
Michael J. Ryback et al. Clinical Infectious Diseases.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. Available online at http://cid.oxfordjournals.org/content/49/3/325.long#sec-1 through http://cid.oxfordjournals.org. Published August 1, 2009. Accessed February 4, 2014.
Test ID: VANCT Vancomycin, Trough, Serum. Mayo Clinic. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81592 through http://www.mayomedicallaboratories.com. Copyright 1995-2014. Accessed February 4, 2014.
Vancomycin. Drugs.com. Available online at http://www.drugs.com/cdi/vancomycin.html through http://www.drugs.com. Issue Date: February 5, 2014. February 4, 2014.
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.
(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.