Table of Contents

AMINOGLYCOSIDE AND VANCOMYCIN SERUM LEVEL MONITORING

(CONVENTIONAL DOSING)

DRUG

INFUSION TIME1

DRAW TIMES1

NORMAL THERAPEUTIC
RANGE (mg/L)

GENTAMICIN & TOBRAMYCIN

30 min

PRE:

within 30 minutes prior to dose

PRE:

< 2.0 mg/L4,5

POST:
greater than or equal to 30 minutes

after end of infusion

POST:

4-10 mg/L2

AMIKACIN

30 min

as for gentamicin and tobramycin

PRE: < 10 mg/L2

POST: 20-30 mg/L2

VANCOMYCIN

< 1250 mg: 60 min

 

 

 

>1250mg: 90 min

PRE:

within 30 minutes prior to dose

 

PRE

5-20 mg/L2,4

POST

greater than or equal to 3 hours

after end of infusion

POST

15-30 mg/L2,3

1        Specify ACTUAL time infusion started, finished and serum level draw times on the drug level requisition form. 
Inaccurate documentation of infusion and draw times will lead to erroneous interpretation of serum levels.

2        Dependent on infection and patient factors.

3        Calculated CPMAX of 20-40mg/L desired; post-vancomycin levels should not be routinely ordered.
Please refer to Vancomycin Empiric Dosing Guidelines: Therapeutic Drug Monitoring section.

4        For hemodialysis (HD) patients measure pre-HD level (ie. immediately prior to HD)

5        For HD patients, pre-HD level gentamicin or tobramcyin levels can go up to < 3.5 mg/L depending on infection (refer to PDTM)

If the guidelines are used, steady-state conditions will usually be reached after 3-4 doses have been administered. 
For this reason, blood sampling on or after the third dose following a change in therapy is recommended. 
In serious infections, earlier blood sampling may be desired.