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Review
. 2025 Apr;48(2):54-59.
doi: 10.18773/austprescr.2025.013.

Safe and effective use of vancomycin

Amy Legg  1   2   3   4   5   6   7   8   9 , Felicia Devchand  1   2   3   4   5   6   7   8   9 , Amanda Gwee  1   2   3   4   5   6   7   8   9 , Indy Sandaradura  1   2   3   4   5   6   7   8   9 , Tony Lai  1   2   3   4   5   6   7   8   9
Affiliations
Review

Safe and effective use of vancomycin

Amy Legg et al. Aust Prescr. 2025 Apr.

Abstract

Vancomycin is an important antimicrobial for prophylactic, empirical and directed therapy of Gram-positive organisms. Therapeutic drug monitoring is recommended for all patients expected to receive vancomycin for more than 48 hours to optimise drug exposure. Monitoring the area under the concentration-time curve over a 24-hour period (AUC24) for vancomycin is preferred over monitoring trough plasma concentrations. An AUC24 of 400 to 600 mg.hr/L is recommended for infections other than central nervous system infections. Vancomycin may cause nephrotoxicity, ototoxicity, cutaneous reactions, hypersensitivity and haematological toxicity. Reducing the incidence of vancomycin-induced nephrotoxicity involves recognising and modifying risk factors where possible.

Keywords: pharmacodynamics; pharmacokinetics; therapeutic drug monitoring; vancomycin.

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Conflict of interest statement

Conflicts of interest: all authors were members of the expert group for Therapeutic Guidelines: Antibiotic version 17. Amy Legg received a travel grant from AstraZeneca in 2022. Amy authored the Herston Infectious Diseases Institute’s Antimicrobial Therapeutic Drug Monitoring guideline. Amy is a member of the Editorial Advisory Committee for Australian Prescriber. She was excluded from editorial decision-making related to the acceptance and publication of this article. Felicia Devchand is an employee of Therapeutic Guidelines Limited, the publisher of Australian Prescriber. Amanda Gwee received grant funding from the National Health and Medical Research Council and the Medical Research Future Fund for her research on antimicrobial drugs in paediatric patients. Indy Sandaradura and Tony Lai received a research grant from Pfizer for the validation of therapeutic drug monitoring assays for isavuconazole, linezolid, ceftaroline and ceftazidime+avibactam in children. Tony has authored antibiotic guidelines for The Children’s Hospital at Westmead and the Australian Neonatal Medicines Formulary.

Figures

Figure 1
Figure 1
Correlation between vancomycin exposure and acute kidney injury
See this image and copyright information in PMC

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