Vancomycin Therapy

Vancomycin exhibits time-dependent bactericidal activity against gram-positive organisms by inhibiting cell wall synthesis. Its pharmacokinetics follow a two-compartment model with distribution into tissues including bone, lung, and peritoneal fluid. Vancomycin is primarily eliminated renally, making dose adjustment essential in renal impairment. Therapeutic drug monitoring via trough levels guides dosing to maintain efficacy while minimizing nephrotoxicity and ototoxicity. The target AUC/MIC ratio of 400-600 is now the preferred pharmacokinetic target over trough-only monitoring. The nurse must manage infusion protocols, interpret trough levels, assess for toxicity, and coordinate with pharmacy for dose adjustments.