Vancomycin is a commonly used clinical glycopeptide antimicrobial drug, which is mainly used for the first-line treatment of gram-positive cocci infections, especially methicillin-resistant Staphylococcus aureus infections (MRSA), and is also the antibiotic of choice for severe infections caused by gram-positive drug-resistant bacteria such as, methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-resistant coagulase-negative staphylococcus (MRCNS), and Enterococcus.

Vancomycin has a narrow therapeutic window, and previous studies have shown that therapeutic drug monitoring for it significantly improves therapeutic efficacy and reduces the risk of nephrotoxicity.

Recommendation 2 Vancomycin TDM is recommended for neonatal/pediatric patients, patients receiving renal replacement therapy (RRT) (very low quality evidence).

Interpretation Vancomycin pharmacokinetic parameters are highly variable in neonatal/ pediatric patients and in patients undergoing RRT. Therefore, vancomycin TDM is considered necessary to improve the clinical efficacy of vancomycin and to reduce the risk of adverse effects.

Recommendation 9 For neonatal/pediatric patients, it is recommended that vancomycin trough concentrations be maintained at 5 ~ 15 mg/L (strong recommendation, low-quality evidence, based on clinical scenarios such as site of infection, severity of infection, etiology, and MIC to determine the appropriate trough concentration for a given patient).

Interpretation The pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of vancomycin in neonates/children may differ from those of adults, and therefore studies relevant to children were analyzed separately. Clinical evidence and expert experience suggests that some neonatal/pediatric patients are effective at steady-state trough concentrations below 10 mg/L, and that increased blood levels pose an additional risk of nephrotoxicity; therefore, a target trough concentration of 5-15 mg/L is recommended for children.

Neonatal/pediatric patients are included as an important part of this vancomycin TDM update, which fully reflects the need for a separate TDM.

Reference range: Trough concentration C₀: 10-15 mg/L in adult patients with common infections; 10-20 mg/L in adult patients with severe MRSA infections; for neonatal/pediatric patients, it is recommended that vancomycin trough concentrations be maintained at 5-15 mg/L.

Alternatively, a target range of 400-650 mg-h/L is recommended for vancomycin AUC_0~24h.

Monitoring time points: Patients with normal renal function, start monitoring 48 h after the first dose; patients with renal insufficiency, start monitoring 72 h after the first dose.

Frequency of monitoring: If the dose administered is adjusted after the initial TDM, monitor again when 4-5 doses are administered after the dose adjustment; repeat monitoring at least weekly in patients admitted to the ICU, receiving vasoactive medications, receiving renal replacement therapy, or with severe infections.

Diagreat has launched a rapid vancomycin blood concentration test kit on the chemiluminescence platform to provide a reference for the effective and safe use of vancomycin in clinical adult and pediatric patients.

Advantages of Diagreat vancomycin test: fully automated, easy to use, fast results (15 min), rapid processing of large sample volumes.

Diagreat offers other antibiotic drug concentration test kits, see the table below.

参考文献：

何娜, 苏珊, 翟所迪, 等.《中国万古霉素治疗药物监测指南(2020更新版)》解读 [J]. 临床药物治疗杂志, 2021, 19(1): 12-16.