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HelpMayo Test ID VANPA Vancomycin, Peak, Serum
Ordering Guidance
In addition to this peak assay, both trough level and random testing are available.
1. Serum for a trough level should be drawn no more than 30 minutes prior to next dose; order VANTA / Vancomycin, Trough, Serum.
2. Serum for random testing should be ordered as VANRA / Vancomycin, Random, Serum.
Specimen Required
Collection Container/Tube: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum for a peak level should be drawn 1 hour after completion of dose.
2. Centrifuge and aliquot serum into a plastic vial within 2 hours of collection.
Useful For
Monitoring peak levels in selected patients receiving vancomycin therapy
Method Name
Immunoassay
Reporting Name
Vancomycin, Peak, SSpecimen Type
Serum RedSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 14 days | |
| Frozen | 365 days | ||
| Ambient | 48 hours |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Vancomycin is an antibiotic used to treat infections caused by gram-positive organisms that are resistant to beta-lactam antibiotics, such as methicillin-resistant staphylococci (MRSA), Streptococcus viridans group, penicillin/cephalosporin-resistant Streptococcus pneumoniae, and penicillin/ampicillin-resistant Enterococcus species.
The oral formulation, which is not absorbed, is used in the treatment of pseudomembranous colitis caused by Clostridium difficile. Vancomycin is also used when patients are intolerant or allergic to beta-lactam antibiotics.
Vancomycin has been associated with nephrotoxicity and ototoxicity, although it appears that many of these reports reflected impurities in early formulations. Monitoring of vancomycin-related nephrotoxicity is recommended only for patients with reduced renal function, those receiving aggressive or prolonged vancomycin regimens, or those at high risk including patients comedicated with other nephrotoxic agents.
Trough concentrations are recommended for therapeutic monitoring of vancomycin, preferably acquired at steady-state (just before fourth dose). To avoid development of resistance, vancomycin trough levels should remain above 10.0 mcg/mL. Complicated infections require higher target levels, typically 15.0 to 20.0 mcg/mL. Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic analyses (eg, area under the curve: AUC studies) or for select patients.
Reference Values
Therapeutic: 20.0-45.0 mcg/mL
Interpretation
Typical peak levels are between 20.0 and 45.0 mcg/mL.
Peak levels are not recommended for monitoring, except in select circumstances such as when performing pharmacokinetic analyses (eg, area under the curve: AUC determination).
These levels are consistent with Mayo Clinic Antimicrobial Therapy Guidelines.
Cautions
As with any assay employing mouse antibodies, the possibility exists for interference by human antimouse antibodies (HAMA) in the sample, which could cause falsely lowered results.
Unspecific binding of heterophilic antibodies from the sample to glucose-6-phosphate dehydrogenase of the reagent may lead to falsely lower test results in very rare cases (<10[-6]).
Clinical Reference
1. Rybak M, Lomaestro B, Rotschafer JC, et al: Therapeutic drug monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66:82-98
2. Estes L, Wilson J: Mayo Clinic Antimicrobial Therapy Quick Guide. Mayo Clinic. 2005. Updated July 29, 2020
Method Description
The assay is based on the kinetic interaction of microparticles in solution (KIMS). Vancomycin antibody is covalently coupled to microparticles and the derivative is linked to a macromolecule. The kinetic interaction of microparticles in solutions is induced by binding of drug-conjugate to the antibody on the microparticles and is inhibited by the presence of vancomycin in the sample. A competitive reaction takes place between the drug conjugate and vancomycin in the sample. A competitive reaction takes place between the drug conjugate and vancomycin in the serum sample for binding to the vancomycin antibody on the microparticles. The resulting kinetic interaction of microparticles is indirectly proportional to the amount of drug present in the sample.(Package insert: Roche Vancomycin reagent, Roche Diagnostic Corp, Indianapolis, IN. 2016-09 Ver. 1)
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 to 2 daysSpecimen Retention Time
1 weekPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
80202
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| VANPA | Vancomycin, Peak, S | 4090-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| VANPA | Vancomycin, Peak, S | 4090-7 |