Vancomycin

This article was on. November 20, 2019

Learn more about...

Healthy Aging

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

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None, but timing of the sample for testing is important; samples are typically collected just before the next dose (trough level). Follow any instructions provided.

Looking For Test Results?

Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Vancomycin is an antibiotic that is used to treat serious infections caused by Gram-positive bacteria. This test measures the concentration of vancomycin in the blood.

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).

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 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 vancomycin taken as a pill by mouth (oral) is poorly absorbed in the digestive tract. However, oral vancomycin may be prescribed to treat some infections of the digestive tract, where absorption into the circulating blood is not needed. An example is Clostridium difficile infection.

Common Questions

How is it used?

This test is used to monitor levels of the antibiotic vancomycin in the blood. When a person takes a dose of vancomycin, the amount in the blood rises for a period of time, peaks, and then begins to fall, usually reaching its lowest level, or trough, just before the next dose. The next dose is timed to coincide with the falling concentration of the drug in the blood.

Because the goal is to administer the vancomycin such that a minimally effective concentration is always maintained in the blood, measurement of blood levels is usually timed to reflect the trough and, sometimes peak, to evaluate the adequacy of dosing and clearance of the drug from the body. Trough levels are collected just prior to a person’s next vancomycin dose. Peak levels are collected 1 to 2 hours after the completion of the intravenous vancomycin dose.

The trough and sometimes peak values are used by clinical pharmacists and healthcare practitioners to calculate rates of absorption and clearance of the drug. These results are then used to determine the appropriate amount of drug and the appropriate timing between doses to assure that the blood concentration remains in the therapeutic range.

For additional information on how the test is used, see Therapeutic Drug Monitoring.

When is it ordered?

There is no widespread consensus on the use of the vancomycin test and when to order it. Some healthcare practitioners will order trough levels every few days throughout vancomycin treatment. Some will order both trough and peak concentrations at regular intervals. Many do not feel that general monitoring is necessary and will only order the tests for those who are at increased risk of kidney damage (nephrotoxicity), who are taking concurrent medications, who have decreased kidney function, or who are not responding to treatment as expected.

What does the test result mean?

Guidelines from 2009 by pharmacists and infectious disease specialists recommend that only trough levels be performed, with a minimum of 10 mcg/mL considered necessary to control an infection. The guidelines recommend a therapeutic range of 15-20 mcg/mL for significant infections. However, many institutions have specific ranges depending on the site of infection and severity of infection.

If trough levels of vancomycin are above the minimum level, then the person should be receiving enough of the drug to be effective. If the person’s infection is not responding to the treatment, then the healthcare practitioner may either continue the drug for a longer period of time or consider other treatment options. If peak concentrations are below maximum levels, then the treated person is at less risk of developing nephrotoxicity and/or ototoxicity but may still experience either complication. Peak concentrations may vary, depending on the consistency of collection timing and on changing drug clearance rates.

If the trough and/or peak concentrations are above the maximum levels, then the person is at an increased risk of toxicity and the healthcare practitioner may either alter the dose or the dosing schedule.

Is there anything else I should know?

An intravenous vancomycin dose must be given slowly. People given the dose at a rapid rate are at an increased risk of developing “red man syndrome,” a histamine reaction that causes flushing of the face, a rash on the upper body, and a significant drop in blood pressure.

Why isn't vancomycin more widely used?

The medical community tries to be conservative in its use of vancomycin, reserving it for patients with few other treatment options to stave off the emergence of vancomycin-resistant microbes. In recent years, some resistant and intermediate (decreased sensitivity) strains of Staphylococcus aureus (called VISA and VRSA for Vancomycin Intermediate/Resistant Staphylococcus aureus) and strains of Enterococcus (Vancomycin-Resistant Enterococcus or VRE) have emerged.

Will I be tested if I am taking oral vancomycin?

Oral vancomycin therapy is rarely monitored as only tiny amounts of the drug are absorbed and carried in the blood. Occasionally, someone with impaired renal function will be monitored to verify that the drug is not building up in their body.

Can I test vancomycin levels at home?

Although someone may receive intravenous vancomycin therapy at home, usually administered by a home health professional, blood levels cannot be monitored at home. The test requires specialized equipment and must be performed in the laboratory. The home health professional may draw a blood sample prior to administering the next dose of drug. This sample will be sent to a laboratory for analysis.

Do some medicines interact badly with vancomycin?

Some drugs do interact with vancomycin. Tell your healthcare practitioner if you are taking any other medicines, especially aminoglycosides, amphotericin B, bacitracin, cisplatin, colistin, polymyxin B, or viomycin. These drugs may increase risk of side effects including kidney toxicity or hearing loss.

View Sources

Sources Used in Current Review

(04/15/2016) MedlinePlus Drug Information. Vancomycin Injection. Available online at https://medlineplus.gov/druginfo/meds/a601167.html. Accessed May 2018.

(05/15/2016) MedlinePlus Drug Information. Vancomycin, oral. Available online at https://medlineplus.gov/druginfo/meds/a604038.html. Accessed May 2018.

Ray A, et. al. Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis. CJASN December 07, 2016 vol. 11 no. 12 2132-2140. Available online at http://cjasn.asnjournals.org/content/11/12/2132.long. Accessed May 2018.

Rybak M, 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. Available online at http://www.ajhp.org/content/66/1/82.full?sso-checked=true. Accessed May 2018.

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.

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.

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.

(1999 June 15). Vancomycin (Systemic). MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/drug-information/DR202590.

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.

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.

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.

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.

(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.

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.

(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. 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. 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. 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.

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. Accessed July 2010.

Swee Leong Yap, MBBS; Chief Editor: Eric B Staros, MD. Vancomycin Level. Medscape. Available online at http://emedicine.medscape.com/article/2090484-overview. Last updated March 16, 2012. Accessed February 4, 2014.

Ben M Lomaestro. Medscape Multispecialty. Available online at http://www.medscape.com/viewarticle/747418_15. 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. 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. Copyright 1995-2014. Accessed February 4, 2014.

Vancomycin. Drugs.com. Available online at http://www.drugs.com/cdi/vancomycin.html. Issue Date: February 5, 2014. February 4, 2014.

Ask a Laboratory Scientist

This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team.