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Does oral vancomycin use necessitate therapeutic drug monitoring?

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Abstract

Purpose

Oral vancomycin use has generally increased as a consequence of the need to treat and/or prevent Clostridium (Clostridiodes) difficile-associated disease (CDAD). This review examines the cumulative scientific evidence that guides therapeutic monitoring of oral vancomycin therapy.

Methods

The existing publications were reviewed from the time of the drug’s inception to July 2019. This review utilized access as available in PubMed, EMBASE, CINAHL Plus, and the Cochrane Library.

Results

Case reports and small patient series have documented anecdotal-associated elevations in serum levels. Correlation of absorbed vancomycin with subsequent toxicity is difficult to determine, but serum levels approaching those obtained after parenteral administration have raised concern. Prolonged usage and total dosing over 500 mg/day among adult age ranges have been associated with accumulation. In addition, risk factors for vancomycin accumulation systemically after oral dosing include renal compromise, combined oral and other enteral therapy, severe CDAD, other intercurrent bowel inflammation, polypharmacy, and increased patient complexity/morbidity.

Conclusion

Until systemic toxicity from oral vancomycin absorption is better understood, individual considerations should be made for therapeutic serum monitoring during oral vancomycin treatment. Therapeutic drug monitoring is suggested for several high-risk situations in which high blood levels may be anticipated.

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  1. Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada

    Nevio Cimolai

  2. Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC, V6H3V4, Canada

    Nevio Cimolai

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Cimolai, N. Does oral vancomycin use necessitate therapeutic drug monitoring?. Infection 48, 173–182 (2020). https://doi.org/10.1007/s15010-019-01374-7

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