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and objective: Routine therapeutic drug monitoring (TDM) of vancomycin is recommended in clinical practice for dose and drug exposure optimisation. Recent guidelines on vancomycin TDM recommend monitoring of through concentrations only with somewhat higher target ranges. The aim of the study was to evaluate the practice of vancomycin TDM in the University Hospital Olomouc and to assess the potential effect of new recommendations on dosing strategies. Methods: A retrospective analysis of vancomycin plasma levels determined during a two-year period was performed. Values with uncertain sample timing and patients on haemodialysis were excluded. The values were assessed according to both the older and the new guidelines. Consecutively, pharmacokinetic modelling was performed for every patient to estimate individual pharmacokinetic-pharmacodynamic indices. Results: A total of 468 vancomycin concentrations were included which represented 260 individual monitoring events performed in 131 patients. Vancomycin was most commonly prescribed for suspected or proven sepsis (49.6 % of all patients). Pathogens with MIC > 1 mg/L were responsible for 18.5 % of all infections. Clinical pharmacologist trained in TDM was consulted in 18.1 % of all events. According to the new guidelines, patients were underdosed in 38.5 % of the events, and overdosed in 39.2 %. Pharmacokinetic simulations showed suboptimal dosing in 28.1 % of the events, and too high dosing in 36.9 % of the events. Conclusion: Dosage adjustments based only upon pre-dose concentrations may be inappropriate, especially if the value is interpreted by a person with lack of experience in the field of TDM.

Therapeutic monitoring of vancomycin in clinical practice