vanco is an ugly ATB used for many things other ATB's won't touch
What are the Vancomycin Peak and Trough?
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Vancomycin may be available in the form of an intravenous injection.
The vancomycin peak and trough represent two extremes in terms of the levels of concentration of this antibiotic in a patient's bloodstream. At the peak, large amounts are circulating, and at the trough, the levels fall very low. Doctors must time dosing with the goal of keeping levels consistent by delivering medication before concentrations reach a trough. For some patients, a doctor may recommend regular monitoring during vancomycin therapy to keep track of levels and adjust doses and timing if necessary.
Risks of taking vancomycin include liver damage.
Risks of taking vancomycin include liver damage.
Vancomycin is a very aggressive antibiotic available in the form of an intravenous injection for treating a number of infections. There are some toxicity concerns with this medication and it is not a first choice treatment. While on vancomycin, a patient may need to stay in the hospital to receive supportive care for an infection, although sometimes it is possible to get injections at home or to receive them on an outpatient basis. It is also important to make sure the infection responds to treatment, and a doctor may need to check on vancomycin peak and trough levels.
A lab can analyze blood to check for vancomycin peak and trough levels.
A lab can analyze blood to check for vancomycin peak and trough levels.
Typically, the medication reaches peak concentration between one and two hours after administration. Depending on the size of the dose, the patient's general health, and other factors, the timing of the trough may vary. A doctor can request a peak reading after administration and check back to see when the patient hits the trough. The health care provider can adjust the timing of future doses to make sure the levels rise before bottoming out, keeping an even amount of medication in the bloodstream.
Vancomycin can be used to treat colitis, a bacterial infection of the intestines.
Vancomycin can be used to treat colitis, a bacterial infection of the intestines.
For some patients on vancomycin, there is a risk of liver or kidney damage. A doctor may need to take vancomycin peak and trough levels to see if a patient has dangerously high levels that might precede organ damage. If the patient's blood reveals high concentrations, the doctor can lower the dose and adjust the timing to address the issue. The goal is to prevent damage by being proactive with medication dosing, keeping the patient as safe as possible during a course of therapy.
Patients usually need to stay in the hospital while receiving vancomycin.
Patients usually need to stay in the hospital while receiving vancomycin.
A hospital lab can analyze blood to check for vancomycin peak and trough levels at a request from a physician. The doctor may write an order in the patient's chart for a nurse to take regular samples and send them to the lab for analysis. With some patients, only a single set of readings is necessary to allow the doctor to perfect the timing of the doses. Other patients may require regular measurements because of concerns about side effects and toxicity.
https://www.thehealthboard.com/what-are-the-vancomycin-peak-and-trough.htm
Vanco was first approved by the FDA in 1958 and is the first-line treatment for methicillin-resistant Staph Aureus (MRSA) infections. It is notorious for being difficult to administer, especially in those with kidney disease. Recommendations to prevent AKI include monitoring drug levels, renal dosing, and withdrawing the drug as early as possible. There are 13 biopsy-proven cases of vanco-induced AKI in the literature. Most AKI’s lasted for three days to four weeks. Only one case report took a longer time (two months) for renal function to improve. ATN-induced cases were rarer (3/13) compared to AIN (8/13) or both (2/13). In all cases, either HD (in the case of acute tubular necrosis (ATN)) or steroids (in the case of acute interstitial nephritis (AIN) was required for the treatment of AKI.[1] This patient had ATN-induced AKI. To our knowledge, this is the first reported case of severe vanco-induced nephrotoxicity that resolved without steroids or HD. In addition, this patient’s vanco levels remained significantly elevated even after SCr levels returned to baseline, suggesting that this patient may have a polymorphism predisposing him to impaired vanco clearance. Further studies exploring the genetics of vanco clearance would be helpful in identifying patients with increased sensitivity. Finally, risk factors for vanco-induced AKI include high BMI, low eGFR, and the combination of vanco with piperacillin-tazobactam (OR, 3.40; 95% CI, 2.57 – 4.50), cefepime, or carbapenem (OR 2.68; 95% CI, 1.83 – 3.91), as in this patient. To address the limitations of using trough concentration as a proxy for measuring the actual AUC value, Bayesian computer software programs have been proposed to estimate the “true” vanco AUC value. Additionally, a number of new anti-MRSA drugs are in development, including novel dalbavancin, telavancin, oritavancin, ceftobiprole and iclaprim.
Conclusions: Vanco is the first-line for the treatment of hospital-acquired MRSA infections in the United States, but monitoring levels has been a complication of its use. This is a unique case of a patient with severe, persistently elevated vanco levels with transient AKI not requiring HD. This patient may have a polymorphism, thus prompting further studies to identify patients with increased predisposition to vanco-induced nephrotoxicity. Risk factors for AKI should be considered, including obesity and concurrent use of other antibiotics. As new measurements and treatments become more widely available, patients with genetic or comorbid risk factors should be offered alternative agents to vanco before beginning treatment.
https://shmabstracts.org/abstract/to-give-or-not-to-give-vancomycin/