How do you interpret a vancomycin trough?
William Smith
Updated on March 30, 2026
Trough concentrations are recommended for therapeutic monitoring of vancomycin, preferably acquired at steady-state (just before fourth dose). To avoid development of resistance, vancomycin trough levels should remain above 10.0 mcg/mL. Complicated infections require higher target levels, typically 15.0 to 20.0 mcg/mL.
When should Vanco trough be drawn?
Trough: just before 4th dose of a new regimen (prior to 3rd dose for dosing intervals ≥ 24 hours or changing renal function) – Trough levels should be obtained within 30 minutes before the next scheduled dose. – Weekly vancomycin levels should be obtained for long-term vancomycin use with stable renal function.
What does trough level indicate?
The trough level is the lowest concentration in the patient’s bloodstream, therefore, the specimen should be collected just prior to administration of the drug. The peak level is the highest concentration of a drug in the patient’s bloodstream.
What does high trough level mean?
What do peak and trough levels indicate? Peak and trough levels indicate drug levels in an individual’s body. A peak is the highest level of a medication in the blood, while a trough level indicates the lowest concentration.
What do you do when Vanco trough is high?
If the high trough level appears genuine, use the vancomycin dose adjustment calculator to obtain a new dosage regime. Consider omitting dose based on the level: – If vancomycin trough level is 20-25mg/L, give new dosage regime without omitting any doses. Take a level before the 4th new dose.
What should a Vanco trough be?
The reference range for vancomycin trough levels is 5-15 mcg/mL. The reference range for vancomycin peak levels is 20-40 mcg/mL.
What is Vanco trough level?
Vancomycin is an antibiotic drug used to treat serious, life-threatening infections by gram-positive bacteria that are resistant to less-toxic agents. The reference range for vancomycin trough levels is 5-15 mcg/mL. The reference range for vancomycin peak levels is 20-40 mcg/mL.
What should Vanco trough be?
What color tube is Vanco trough?
Red-top tube, lavender-top (K2- or K3- EDTA) tube, or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel.
How do you do a Vanco trough?
Other instructions are as follows:
- Do not draw specimens until steady state is achieved (ie, before fourth dose)
- Draw trough specimen immediately before (≤30 min) next dose.
- Draw peak specimen 1-2 hours after completion of intravenous dosage.
What is a normal trough level for vancomycin?
If the trough is above 15-20 mg/L, consider decreasing the dose and/or lengthening the dosing interval If trough level is significantly elevated (i.e. greater than 25 mg/L) hold vancomycin and use repeat levels to determine when to restart vancomycin and new dosing regimen
What is the optimal trough concentration for infective endocarditis?
Optimal trough concentrations: complicated infections (endocarditis, osteomyelitis, meningitis, hospital-acquired pneumonia caused by Staphylococcus aureus) Trough concentrations of 15–20 mg/l recommended to improve penetration, increase probability of target attainment and improve clinical outcomes.
When are vancomycin troughs indicated in dialysis?
Usually only vancomycin troughs are needed. Random levels may be obtained on patients with poor renal function who only receive intermittent or post-dialysis dosing. At minimum, levels should be obtained for all patients by 72 hours of therapy and at least weekly thereafter. Many patients will require more frequent monitoring.
When is a trough level of 15 mg/L indicated?
Serious infections where rapid attainment of target trough level of 15-20 mg/L is desired, e.g. vertebral osteomyelitis, MRSA pneumonia, epidural abscess, septic shock. Patients with significant renal dysfunction in order to decrease the time required to attaintarget trough level.
