There is a significant amount of controversy regarding the most appropriate therapeutic goal for vancomycin therapy. The difference of opinion stems from the pharmacodynamic activity of vancomycin.
Vancomycin is typically given as an intermittent infusion adjusted for body weight and renal function. Some clinicians believe that a continuous infusion of vancomycin may simplify therapy and make serum vancomycin levels more consistent.
Because continuous infusion vancomycin is a rare clinical occurrence, there is a lack of data regarding the optimal “plateau” level (serum drug level during continuous infusion therapy). Current evidence suggests that the vancomycin AUC:MIC ratio is the most important pharmacodynamic parameter associated with treatment success.1 Given that current guidelines recommend an AUC:MIC ratio of at least 400, a plateau of 20-25 mcg/mL (20 mcg/mL * 24 hrs) would provide an AUC:MIC ratio > 400 for isolates with an MIC of 1-1.5 mcg/mL. Continue reading