What is considered a therapeutic peak range for vancomycin when used to treat meningitis?

• A. 10-20 mcg/mL
• B. 20-30 mcg/mL
• C. 30-40 mcg/mL
• D. 40-50 mcg/mL

Answer: (C)

The level of vancomycin exposure needed for meningitis is higher than for many other infections because you must achieve CSF concentrations that reliably exceed the pathogen’s MIC to eradicate the infection quickly. Although vancomycin kill is primarily tied to overall exposure (AUC/MIC) rather than a single peak, ensuring a higher peak helps push CSF concentrations into a therapeutic range early in therapy, especially when meningitis is involved. Therefore, a peak in the 30–40 mcg/mL range is described as the therapeutic target for meningitis, reflecting the need for greater penetration and sustained activity in the CSF. In contrast, lower peaks (10–20 or 20–30) may be insufficient for meningitis, while extremely high peaks (40–50) are not routinely required and can increase toxicity without added benefit.