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10/08/18 JE -- Pharmacokinetic Consultation Service and Vancomycin Policy

From: Jonathan Edwards
Sent: Monday, October 8, 2018 8:36:37 AM
Subject: Pharmacokinetic Consultation Service and Vancomycin Policy

Attachments: Vancomycin Dosing for Scheduled Hemodialysis

Vancomycin CE Handout    

Pharmacokinetic Consultation Service

 

Pharmacists,

I have received a few questions regarding when to order labs for patients receiving vancomycin therapy.  Please take a moment to review the attached documents regarding our PKS service and monitoring parameters.  I wanted to highlight the recommendations regarding vancomycin monitoring:

Recommended Monitoring:

  1. Baseline serum creatinine within 36 hours of initiating vancomycin therapy then at least every 48 hours thereafter
  2. Vancomycin trough levels weekly
  3. Check vancomycin through when continuing home vancomycin regimens within 48 hours of admission if no access to pre-admission vancomycin levels

These recommendations are at a minimum.  If more intense monitoring is warranted, labs may be ordered as needed.  Please let me know if you have any questions.

Thank you,

Jonathan

--

Jonathan D. Edwards, Pharm. D., BCPS-AQ ID, BCGP
Pharmacy Specialist, Internal Medicine & Infectious Disease






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