Peaks and troughs and vanc dosing

When do you get a vanc trough? What about a peak? What does it mean, anyway?

Vancomycin is a renally cleared drug used to treat serious infections. A vanc TROUGH is obtained when you expect the patient to be treated for a serious/life-threatening infection, to be treated with other nephrotoxic medications at the same time, or to be treated for >4 days. A trough should be obtained within 30 mins before the 4th dose.

A vanc PEAK is obtained less frequently, when high penetration of a hard-to-reach space is required (osteomyelitis or endocarditis). It should be obtained an hour after vanc finishes infusing.

A RANDOM vanc level should only be obtained in patients on dialysis or with severe renal disease.

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