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Thomas E. Johns, PharmD; Peter Iafrate, PharmD; Thomas T. Sproat, PharmD; Shirley Palmer, PharmD
University of Florida Gainesville

JAMA. 1996;275(12):911.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In a recent consensus report by Dr Wilson and colleagues¹ on the current treatment of endocarditis in adults, recommendations regarding dosing and pharmacokinetic monitoring of vancomycin hydrochloride warrants clarification and reevaluation. Development of the so-called therapeutic range for vancomycin resulted from the perceived relationship between drug concentration and toxicity. Potential ototoxicity and nephrotoxicity in relation to specific levels of vancomycin have not withstood vigorous challenges to their validity.² Similar to β-lactams, vancomycin exerts its bactericidal actions by inhibiting bacterial cell wall synthesis, a process that is relatively independent of concentration. Consequently, drug concentrations exceeding four to five times the minimum inhibitory concentration (MIC) are not necessary; instead, maintaining drug concentrations above the MIC of the organism for the entire dosing interval is desired. The current recommendation by Wilson and colleagues requires therapeutic vancomycin peak concentrations of 30 to 45 µg/mL for twice-daily dosing. In clinical . . . [Full Text PDF of this Article]

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