For serious MRSA and other deep Gram-positive infection, target an area-under-the-curve to minimum-inhibitory-concentration ratio (AUC/MIC around 400-600) using Bayesian or two-level monitoring, rather than chasing a trough concentration alone. Trough-only dosing tends to push exposure higher and raises nephrotoxicity without added benefit.
Monitor early and repeat when renal function is changing, in obesity, and on renal replacement therapy, where clearance is unpredictable. Give a loading dose in serious infection so therapeutic exposure is reached quickly, and involve pharmacy for dose individualisation.
- Target AUC/MIC (about 400-600) for serious vancomycin indications, not trough alone.
- Trough-only dosing raises nephrotoxicity risk without better efficacy.
- Monitor early and repeat with changing renal function, obesity or renal replacement therapy.
- Use a loading dose in serious infection and involve pharmacy for individualised dosing.
Why it matters
Trough-guided vancomycin overshoots exposure and drives avoidable kidney injury without improving outcomes.
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