Vancomycin goal levels

[pharmboycu]

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Ah, I see where you are coming from. But if they are coming down form ICU, it means they've been there a while, and shouldn't they have C&S by that point? Of course, if it's a new infection that's developed during the hospital stay, then yeah, I can see why you would be much more likely to suspect MRSA. But that would suggest poor infection control is probably the main issue here.

There are so many issues at play here... being a general medicine floor means I get all kinds of patients. Most of them are step down, a few are direct admits, occasionally an ER patient... but in general, at least here, if it comes back as Gm+ cocci clusters the odds are it's MRSA needing 15-20. It's kinda like being a poker player when someone bets three times the big blind. Do you call or not? At this particular table, the odds are best for me to call. Hahaha... 👍

 

[xiphoid2010]

There are so many issues at play here... being a general medicine floor means I get all kinds of patients. Most of them are step down, a few are direct admits, occasionally an ER patient... but in general, at least here, if it comes back as Gm+ cocci clusters the odds are it's MRSA needing 15-20. It's kinda like being a poker player when someone bets three times the big blind. Do you call or not? At this particular table, the odds are best for me to call. Hahaha... 👍

I don't think you need to dose every MRSA to 15-20. I think the new IDSA's MRSA guideline has criteria for that as well.

Also, if you have a chance, take a look at your MIC90 at your institution. If it's >1, I can definitely see why your medical center would dose everyone empirically 15-20. Luck for us, we haven't had the "MIC creep" that some medical centers have had. *knock on wood* But if the MIC does go up in the future, I would make the recommendation for high troughs empirically as well.

 

[pharmboycu]

I don't think you need to dose every MRSA to 15-20. I think the new IDSA's MRSA guideline has criteria for that as well.

Also, if you have a chance, take a look at your MIC90 at your institution. If it's >1, I can definitely see why your medical center would dose everyone empirically 15-20. Luck for us, we haven't had the "MIC creep" that some medical centers have had. *knock on wood* But if the MIC does go up in the future, I would make the recommendation for high troughs empirically as well.

Great discussion, but I think we'll just have to agree to disagree, knowing full well that neither of us knows the full story at each other's institution. 🙂

 

[xiphoid2010]

Great discussion, but I think we'll just have to agree to disagree, knowing full well that neither of us knows the full story at each other's institution. 🙂

Let's shake. Always good to have a deep discussion on the best way to take care of the patients. Even if we don't agree, at last we are both looking out for our patient population the best we can..

 

[pharmboycu]

Let's shake. Always good to have a deep discussion on the best way to take care of the patients. Even if we don't agree, at last we are both looking out for our patient population the best we can..

+1. Consider it done my friend! 👍

 

[KARM12]

Quitters...

I generally follow the trough goals from IDSA based on indication.

 

[Praziquantel86]

Quitters...

I generally follow the trough goals from IDSA based on indication.

That's the question, how do you interpret the omitted indications in the guideline?

 

[StewardshipDude]

"linezolid loses it's patent in January 2015. In February 2015 we will have linezolid in about every empiric pathway in the medical center, save endocarditis." - Our VP of Quality (who my boss the DOP reports to)

 

[Praziquantel86]

"linezolid loses it's patent in January 2015. In February 2015 we will have linezolid in about every empiric pathway in the medical center, save endocarditis." - Our VP of Quality (who my boss the DOP reports to)

That'll go over real well.