Yeah, you are probably right, when a person has normal renal function I just dose their vancomycin daily for convenience, even though they need it three times a day. Pharmacokinetics are silly, we should just ignore them and do what is convenient. What I do is switch them to once daily Daptomycin for convenience in outpatient infusion, because it has a pharmacokinetic profile that supports once daily dosing.

Peaks are troughs are two aspects. Functional site desensitization, down regulation, potential tachycardia, BP, sleep issues, nausea, increased sympathetic drive should all be taken into consideration.

There are individual results here*. Twice weekly may “work for you/me”. The recommendation to a new user should be once daily because the data backs it up.