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The following message was posted to: PharmPK
Happy Holidays all!
I need your help.
I am looking for any references with information on Vancomycin trough being
in the range of 5-15mcg/ml instead of 5-10mcg/ml in treating MRSA
bacteremia.
I worked in a hospital where the ID folks were adamant on monitoring and
redosing patient if the trough level was below 10, specifically due to high
rates of MRSA in that hospital
Thanks
Goldina Ikezuagu,Pharm.D
WRAMC
202-782-0681
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The following message was posted to: PharmPK
Dr. Goldina,
The higher troughs used in MRSA may be related
to the MRSA literature regarding the MBC:MIC ratio
cutoff point of 32:
Sorell, T.C. et al., Vancomycin therapy for
MRSA, Ann Internal Medicine 1982;97:344-50
Mike Leibold, PharmD, RPh
m_leibold.-a-.hotmail.com
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The following message was posted to: PharmPK
Dear Ikezuagu,
What we look for in dosing vancomycin is maintaining the trough level at
least four times the MIC of the organism. The literature seems to support twice
the MIC but as vanco is ~50% protein bound, the doubling is warrented. Bear in
mind that this is the minimum. Therefore, if you have a MRSA with a MIC of 2,
you need at least a trough level of 8mcg/ml. Again, this is the minimum -
higher troughs are even better.
The toxicity of vancomycin and the standard serum level parameters seem to
be based on earlier products (Remember when Vanco was called 'Mississippi
Mud"?) which had significant impurities. In practice, current vancomycin
preparations seem to be less toxic.
We routinely let vancomycin trough levels of 15mcg/ml go by and have not
had any problems. One disclaimer though, when combined with another potentially
nephrotoxic agent, we become much more conservative.
I'm assuming that you are using some sort of modeling software. If not, I
would highly recommend it.
Bob Brennan
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