Original Article

Ann Lab Med 2014; 34(1): 1-6

Published online January 1, 2014

Copyright © Korean Society for Laboratory Medicine.

Assessment of Therapeutic Drug Monitoring of Vancomycin in Elderly Patients According to New Guidelines

Se Jin Oh, M.D.1, Ki-Sook Hong, M.D.1, Eun Jeong Lee, R.Ph.2, Hee Jung Choi, M.D.3, Kyoung Ae Kong, M.D.4, Miae Lee, M.D.1, and Wha Soon Chung, M.D.1

Departments of Laboratory Medicine1, Pharmacy2, and Internal Medicine3, Ewha Clinical Trial Center4, Ewha Womans University School of Medicine, Seoul, Korea

Correspondence to: Ki-Sook Hong
Department of Laboratory Medicine, Ewha Womans University School of Medicine, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea
Tel: +82-2-2650-2822
Fax: +82-2-2650-5091

Received: April 15, 2013; Revised: June 21, 2013; Accepted: August 25, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Concerns regarding increasing microbial resistance to vancomycin have resulted in recommendations for a higher trough serum vancomycin concentration. This study aimed to assess the dosage guidelines targeting vancomycin trough concentrations of 15-20 mg/L. Methods: About 216 adult patients (age, >60 yr) were treated with intravenous vancomycin. The patients were divided into 2 groups according to their target vancomycin trough concentrations: the previous guideline group (n=108) treated with targeted vancomycin trough concentrations of 5-15 mg/L from Jan 2009 through April 2011 and the new guideline group (n=108) treated with targeted concentrations of 15-20 mg/L from November 2011 through July 2012. Results: The 2 groups were not significantly different with respect to age, weight, initial serum creatinine, initial creatinine clearance, predictive trough levels, doses, serum drug concentrations, and area under the curve/minimal inhibitory concentrations. Regarding the proportions of vancomycin trough concentrations, the target range was achieved in 50% in the previous guideline group and in 16% in the new guideline group. In the previous and new guideline groups, the trough concentrations of 10-20 mg/dL were observed in 32.4% and 52.8% patients, respectively, and those of <10 mg/L were observed in 45.4% and 29.6%, respectively. Conclusions: Compared to the previous guideline group, the new guideline group showed higher proportions in the therapeutic range of 10-20 mg/L and lower proportions in trough concentrations <10 mg/L. The strictly managed vancomycin therapeutic drug monitoring in the new guideline group was assessed as more effective.

Keywords: Therapeutic drug monitoring, Vancomycin, Trough concentration