Tijdschrift voor geneeskunde vol:61 issue:17 pages:1209-1216
Significance of measurement of vancomycin peak serum concentrations
The glycopeptide antibiotic vancomycin is frequently used in Gram-positive infections. Still, until today, much controversy exists about possible toxicity, especially as concerns the significance of peak values in therapeutic drug monitoring. According to American guidelines published in 1998 and several other authors, peak values are useless.
A retrospective analysis at the university hospitals of Leuven reveals that a minority of peak values (9,8%) exceeded the possibly toxic value of 50 mg/l. One third of these possibly toxic values correlated with a high trough value (> 15 mg/l) and would have been detected anyway.
"Missed" possibly toxic peaks are peak values which exceed the arbitrary value of 50 mg/l although preceded by a normal trough value. These peaks occurred especially at a 1000 mg vancomycin dose and in patients with a good renal function. Based on the international literature and the results of this study, we suggest that peak measurements are not longer necessary.