JAC Advance Access published online on October 8, 2002
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkf212
© 2002 by The British Society for Antimicrobial Chemotherapy
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Original Paper
1 Bristol Centre for Antimicrobial
Research and Evaluation, Department of Microbiology, Southmead Hospital,
North Bristol NHS Trust, Bristol BS10 5NB
* Corresponding author. E-mail: tobinc{at}southmead.swest.nhs.uk.
Received 24 May 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
Keywords: vancomycin, therapeutic drug monitoring, questionnaire
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
2 Pharmacy Department and Department of Medicine
and Therapeutics, Western Infirmary, North Glasgow Hospitals Trust, Glasgow
3 Microbiology Department,
Southern General Hospital, Glasgow
4 Department of Pharmacology, Therapeutics and Toxicology,
University of Wales College of Medicine, Cardiff, UK
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.
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