JAC Advance Access originally published online on October 8, 2002
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Journal of Antimicrobial Chemotherapy (2002) 50, 713-718
© 2002 The British Society for Antimicrobial Chemotherapy
Vancomycin therapeutic drug monitoring: is there a consensus view? The results of a UK National External Quality Assessment Scheme (UK NEQAS) for Antibiotic Assays questionnaire
1 Bristol Centre for Antimicrobial Research and Evaluation, Department of Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB; 2 Pharmacy Department and Department of Medicine and Therapeutics, Western Infirmary, North Glasgow Hospitals Trust and 3 Microbiology Department, Southern General Hospital, Glasgow; 4 Department of Pharmacology, Therapeutics and Toxicology, University of Wales College of Medicine, Cardiff, UK
Received 24 May 2002; returned 7 August 2002; revised 21 August 2002; accepted 21 August 2002
This study investigated vancomycin therapeutic drug monitoring (TDM) and issues related to patient management. Questionnaires were distributed to 310 participants in the UK National External Quality Assessment Scheme (NEQAS) for Antibiotic Assays. The response rate was 57.4%. The majority (76%) had an ‘in-house’ assay service based, almost exclusively, in the microbiology department, and a fluorescence polarization immunoassay (FPIA) was used by 97%. Almost half (48.7%) had an assay service available for 24 h/day, 7 days/week and 92.7% expected same-day results. The majority (80%) had issued guidelines for vancomycin use. A 12 hourly initial dosing regimen was used by 89%. Trough assay samples were taken <10 min before the dose by 91.5%. For post-dose assay samples, 44% took a sample at 1 h, 28% at 2 h and the remainder at ‘other’ times. For trough target ranges, 93% quoted <10 mg/L or 5–10 mg/L. There was no consensus with regard to post-dose assay sample times and 23 ranges were quoted. The majority (74.4%) regarded a trough level of 
10 mg/L as ‘toxic’ but 13 concentrations were quoted as toxic post-dose measurements. In conclusion, there was a wide variability and poor consensus with regard to post-dose vancomycin assay sampling times, target ranges and what constituted a toxic level.
Keywords: vancomycin, therapeutic drug monitoring, questionnaire
* Corresponding author. Tel: +44-117-959-5654; Fax: +44-117-959-3217; E-mail: tobin_c{at}southmead.swest.nhs.uk
Deceased.
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