1) Vancomycin trough concentrations should always be maintained at >10 ug/mL to avoid the development of resistance.
2) For serious Staphylococcus aureus infections such as septicemia, infective endocarditis, osteomyelitis, meningitis, pneumonia and severe SSTI (necrotizing fascititis), vancomycin trough concentrations of 15-20 ug/mL are recommeneded.
3) Vancomycin induced nephrotoxicity is indicated when serum creatinine increase of 0.5 mg/dL or 50% from baseline (whichever greater) is observed after several days of therapy in the absence of an alternative explanantion. Recommend a minimum of two or three consecutive serum creatinine concentrations to monitor possible nephrotoxicity during the course of therapy.
Trough concentrations are most accurate and recommended for therapeutic monitoring of Vancomycin preferably obtained just prior to the next dose at steady-state condition (just before the fourth dose with normal renal function). Evidence does not support monitoring peak concentrations to decrease the frequency of nephrotoxicity.