Antibiotic and antifungal monitoring

Test

Sample Type

Target Range

Notes

Timing of laboratory assay runs

Antibiotics

Antibiotic assays are performed by the Biochemistry Department. Ring the Biochemistry Department for results. For advice, contact the Microbiology Department.

Amikacin (multiple daily dosing)

Serum, pre-dose trough

and at one hour post-dose peak

Trough: <10,

Peak: 20-30,

Toxic level: >35mg/L

Daily, 10 a.m. and 4 p.m.

Gentamicin or Tobramycin, multiple daily dosing (BD or TDS).

Serum, pre-dose trough

and one hour post-dose peak

Trough <2.0,

Peak 6-10 mg/L

Take trough and peak levels after 24 hours i.e. at the 3rd dose for BD dosing and at the 4th dose for TDS dosing.

Normal renal function - monitor levels every 3-5 days

Impaired renal function - monitor levels daily

Daily, 10 a.m. and 4 p.m.

Gentamicin or Tobramycin, Extended interval (once daily)

Serum pre-dose

Trough < 1 mg/l

Normal renal function - (creatinine clearance >60ml/min) give next dose when due. Check pre-dose levels every 3-5 days.

Impaired renal function - monitor levels daily

Teicoplanin

Serum, pre-dose trough only

20-60 mg/l for severe infections

10-60 mg/l for other infections

Monitoring is required for patients with impaired renal function / to ensure therapeutic plasma levels.

Ensure that usual BD loading dose is given
Take pre-dose level on day 4 to 7.

Regular monitoring may be required in renal impairment

Tuesday & Friday at noon

Vancomycin

see also Antimicrobial Formulary: 21. Vancomycin monitoring – Good practice guideline

Serum, pre-dose trough

Trough 10-15 mg/L

Peak <30 mg/L

Take pre-dose levels prior to 3rd dose. Give the 3rd dose as prescribed and amend 4th dose according to levels

Normal renal function - (creatinine clearance >60ml/min): check levels every 3-5 days.

For severe infections, higher levels may be advised by microbiology.

Daily 10 a.m./4 p.m.

Antifungal Assays

Send specimens to the Microbiology Department, which will forward to the Mycology Department where assays are performed. (ext 2124)

Turnaround Times: average 1.4 days

Please refer to the Regional Mycology Laboratory Section of this Handbook for further information on Antifungal Assays

Test	Sample Type	Target Range	Notes	Timing of laboratory assay runs
Antibiotics Antibiotic assays are performed by the Biochemistry Department. Ring the Biochemistry Department for results. For advice, contact the Microbiology Department.
Amikacin (multiple daily dosing)	Serum, pre-dose trough and at one hour post-dose peak	Trough: <10, Peak: 20-30, Toxic level: >35mg/L		Daily, 10 a.m. and 4 p.m.
Gentamicin or Tobramycin, multiple daily dosing (BD or TDS).	Serum, pre-dose trough and one hour post-dose peak	Trough <2.0, Peak 6-10 mg/L	Take trough and peak levels after 24 hours i.e. at the 3rd dose for BD dosing and at the 4th dose for TDS dosing. Normal renal function - monitor levels every 3-5 days Impaired renal function - monitor levels daily	Daily, 10 a.m. and 4 p.m.
Gentamicin or Tobramycin, Extended interval (once daily)	Serum pre-dose	Trough < 1 mg/l	Normal renal function - (creatinine clearance >60ml/min) give next dose when due. Check pre-dose levels every 3-5 days. Impaired renal function - monitor levels daily	Daily, 10 a.m. and 4 p.m.
Teicoplanin	Serum, pre-dose trough only	20-60 mg/l for severe infections 10-60 mg/l for other infections	Monitoring is required for patients with impaired renal function / to ensure therapeutic plasma levels. Ensure that usual BD loading dose is given Take pre-dose level on day 4 to 7. Regular monitoring may be required in renal impairment	Tuesday & Friday at noon
Vancomycin see also Antimicrobial Formulary: 21. Vancomycin monitoring – Good practice guideline	Serum, pre-dose trough	Trough 10-15 mg/L Peak <30 mg/L	Take pre-dose levels prior to 3rd dose. Give the 3rd dose as prescribed and amend 4th dose according to levels Normal renal function - (creatinine clearance >60ml/min): check levels every 3-5 days. For severe infections, higher levels may be advised by microbiology.	Daily 10 a.m./4 p.m.
Antifungal Assays Send specimens to the Microbiology Department, which will forward to the Mycology Department where assays are performed. (ext 2124) Turnaround Times: average 1.4 days Please refer to the Regional Mycology Laboratory Section of this Handbook for further information on Antifungal Assays