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Using guideline recommendations, trough levels were all drawn immediately before the fourth dose of vancomycin to approximate steady-state conditions (4 to 5 half-lives) [ 4, 5].
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Investigators were not provided with specific vancomycin trough recommendations as there were no authoritative guidelines available when the studies were conducted.
In addition, it is important to note that the support for the vancomycin trough concentration recommendations are graded as IIIB (moderate evidence for support and from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees), which is rather soft [ 8].
The recommendations include adjustment to blood trough levels for the two drugs or dosing adaptation based on elevated serum creatinine levels.
However, ototoxicity is a common problem and is monitored using peak and trough amikacin concentrations based on World Health Organization recommendations.
23– 27 The results of these studies prompted an expert recommendation for administration of higher vancomycin doses with targeted trough levels of 15 20 μg/mL when treating MRSA pneumonia.
Despite the results of several studies that have concluded that an area under the curve (AUC /minimum inhibitory concentration (MIC) ratio above 400 is required to achieve successful treatment for Methicillin-resistant Staphylococcus aureus (MRSA) infection [12-14] [12-14]neral recommendathens for MRSA infections are vancomcycin II with a targeneralugh of 15 mcg/ml to 20 mcg/ml.
Goal vancomycin trough concentrations for II were in accordance with the Infectious Disease Society of America guideline recommendations, with 15 mcg/ml to 20 mcg/ml for severe infection [8].
Goal vancomycin trough concentrations for II were in accordance with the Infectious Disease Society of America guideline recommendations, with 15 mcg/ml to 20 mcg/ml for severe infection [ 8].
Trough achievement in clinical practice was 22% when institutional dosing interval recommendations were followed compared with 20% when not followed (P = 0.8).
They upgraded Europe's media sector to an "overweight" recommendation from "underweight" saying "it has underperformed all other cyclicals since the market trough".
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