For patients with severe, deep-seated infections (including but not limited to meningitis, pneumonia osteomyelitis, endocarditis, bacteremia and prosthetic joint infection) a serum trough concentration of 15 to 20 µg/mL is recommended <ref name="[17]">Consgrove, S.E., Avdic, E., Dzintars, K. & Smith, J. (2015). Antibiotic Guide. ''Johns Hopkins Medicine, The Johns Hopkins Hospital Antimicrobial Stewardship Program.''</ref><ref name="[18]">Drew, R.H. & Sakoulas, G. (2017). Vancomycin: Parenteral dosing, monitoring, and adverse effects in adults. Accessed on 26 September 2017, at ''https://www.uptodate.com/contents/vancomycin-parenteral-dosing-monitoring-and-adverse-effects-in-adults.''</ref>. To achieve this concentration more rapidly an initial loading dose of 20-25 mg/kg is often given, followed by intermittent maintenance dosing of typically around 15-20 mg/kg every 8 to 12 hours <ref name="[17]" />. Patients with less severe infections (soft tissue infections) do not require a loading dose, and are started immediately on intermittent dosing with the aim of achieving a minimum serum trough concentration of 10-15 µg/mL <ref name="[18]" />. Trough concentrations are measured as these constitute the most practical and accurate indicator for treatment effectiveness and toxicity. Peak levels are rarely measured and are not clinically relevant <ref name="[17]" />.

!Target group

!Loading Dose

| -

|10 – 15 µg/mL

There is large interpatient variability in vancomycin pharmacokinetics <ref name="[19]">Carter, B.L., Damer, M.K., Walroth, T.A., Buening, N.R., Foster, D.R. (2015). A systematic Review of Vancomycin Dosing and Monitoring in Burn Patients. ''Journal of Burn Care & Research, 36'', 641-650. [https://doi.org/10.1097/BCR.0000000000000191 doi:10.1097/BCR.0000000000000191]</ref>. The rate of clearance of vancomycin depends on the following factors; pathogen susceptibility to the drug, disease severity, the site of the infection, patient weight, age, gender and renal function <ref name="[18]" />. As vancomycin is largely cleared through the kidneys, the effect of renal function is especially great. Groups of patients demonstrating rapid clearance, such as young children with naturally high renal function and burn patients, require significantly more frequent dosing than patients with normal renal function to achieve the same target trough concentrations <ref name="[17]" /><ref name="[18]" /><ref name="[19]" />. In contrast, patients with impaired renal function may require dose reductions or extended dosing intervals in order to stay within the therapeutic range <ref name="[17]" /><ref name="[18]" />.

The SensUs competition wants to stimulate the development of molecular biosensing devices, which are small devices that can be used at the bedside of patients or even at home. Currently no handheld or table-top point-of-care devices for detecting vancomycin are available on the market. The devices listed below in Table 2 are all large instruments which can only be found in laboratory environments.

!Company

!Product

|CV <5%

|8-9 min.

All products in Table 2 make use of enzyme immunoassays to detect vancomycin in blood plasma or serum, these are explained in more detail in the next section. Almost all plasma stabilising anticoagulants are compatible with the assays - EDTA K2 or K3, Li -heparin, etc. - as vancomycin does not react with any of these reagents <ref name="[24]" /><ref name="[25]" /><ref name="[26]" />.