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Test ID: VANRA Vancomycin, Random, Serum

Useful For

Monitoring adequacy of drug concentration during vancomycin therapy whenever a specimen is submitted or collected without collection timing information

Method Name

Immunoassay

Reporting Name

Vancomycin, Random, S

Specimen Type

Serum Red


Ordering Guidance


In addition to this random assay, both peak level and trough level testing are available.

1. Serum for a peak level should be drawn 1 hour after completion of dose; order VANPA / Vancomycin, Peak, Serum.

2. Serum for a trough level should be drawn no more than 30 minutes prior to next dose; order VANTA / Vancomycin, Trough, Serum.



Specimen Required


Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions: Centrifuge and aliquot serum within 2 hours of collection.


Specimen Minimum Volume

0.25 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 14 days
  Frozen  365 days
  Ambient  48 hours

Clinical Information

Vancomycin is an antibiotic used to treat infections caused by gram-positive organisms that are resistant to beta-lactam antibiotics, such as methicillin-resistant staphylococci (MRSA), Streptococcus viridans group, penicillin/cephalosporin-resistant Streptococcus pneumoniae, and penicillin/ampicillin-resistant Enterococcus species. The oral formulation, which is not absorbed, is used in the treatment of pseudomembranous colitis caused by Clostridium difficile. Vancomycin is also used when patients are intolerant or allergic to beta-lactam antibiotics.

 

Vancomycin has been associated with nephrotoxicity and ototoxicity, although it appears that many of these reports reflected impurities in early formulations. Monitoring of vancomycin-related nephrotoxicity is recommended only for patients with reduced renal function, those receiving aggressive or prolonged vancomycin regimens, or those at high risk including patients comedicated with other nephrotoxic agents.

 

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. Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic studies or for select patients.

 

Random levels may be ordered when attempting to determine when to dose vancomycin in patients with renal impairment or those undergoing dialysis.

Reference Values

VANCOMYCIN, TROUGH

Therapeutic: 10.0-20.0 mcg/mL

 

VANCOMYCIN, PEAK

Therapeutic: 20.0-45.0 mcg/mL

Interpretation

Trough levels correlate better with efficacy than peak levels, with target trough levels of 10.0 and 20.0 mcg/mL, depending on the type of infection.

 

Peak levels are not recommended for monitoring, except in select circumstances such as when performing pharmacokinetic analyses (eg, area under the curve: AUC determinations). Typical peak levels are between 20.0 and 45.0 mcg/mL.

 

These levels are consistent with Mayo Clinic Antimicrobial Therapy Guidelines.

Clinical Reference

1. Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic drug monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66:82-98

2. Estes L, Wilson J: Mayo Clinic Antimicrobial Therapy Quick Guide. Mayo Clinic. 2005. Updated July 29, 2020

Day(s) Performed

Monday through Sunday

Report Available

Same day/1 to 2 days

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

80202

LOINC Code Information

Test ID Test Order Name Order LOINC Value
VANRA Vancomycin, Random, S 20578-1

 

Result ID Test Result Name Result LOINC Value
VANRA Vancomycin, Random, S 20578-1

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.

Mayo Clinic Laboratories | Therapeutics Catalog Additional Information:
mml-antibiotics, mml-drugmonitoring