Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Individualization of vancomycin dosing based on therapeutic drug monitoring (TDM) data is known to improve patient outcomes compared with fixed or empirical dosing strategies. There is increasing evidence to support area-under-the-curve (AUC(24))-guided TDM to inform vancomycin dosing decisions for patients receiving therapy for more than 48 hours. It is acknowledged that there may be institutional barriers to the implementation of AUC(24)-guided dosing, and additional effort is required to enable the transition from trough-based to AUC(24)-based strategies. Adequate documentation of sampling, correct storage and transport, accurate laboratory analysis, and pertinent data reporting are required to ensure appropriate interpretation of TDM data to guide vancomycin dosing recommendations. Ultimately, TDM data in the clinical context of the patient and their response to treatment should guide vancomycin therapy. Endorsed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology, the IATDMCT Anti-Infectives Committee, provides recommendations with respect to best clinical practice for vancomycin TDM.

Automated summary

Individualized vancomycin dosing based on therapeutic drug monitoring (TDM) data is proven to be more effective than fixed or empirical dosing strategies. Area-under-the-curve (AUC(24))-guided TDM is increasingly supported for vancomycin dosing decisions in patients receiving treatment for more than 48 hours. However, institutional barriers may hinder the implementation of AUC(24)-guided dosing, requiring additional effort to transition from trough-based strategies. Proper documentation, storage, transport, laboratory analysis, and data reporting are essential for appropriate interpretation of TDM data to guide vancomycin dosing recommendations. The International Association of Therapeutic Drug Monitoring and Clinical Toxicology provides recommendations for best clinical practice in vancomycin TDM.