Objective To evaluate the necessarity of therapeutic drug monitoring (TDM) of vancomycin in clinical use. Methods Different databases were searched including the Cochrane Library, Pubmed,Medline, Embase, CBM and CNKI for randomized controlled trials a-bout TDM of vancomycin. Three clinical studies were involved into this systematic review, including 332 patients. The Cochrane Collaboration's RevMan 4.2.10 software was used for meta analysis. Results Meta analysis displayed that no significant difference was observed in the du-ration of therapy, the cumulative total dose, and creatinine clearance (CLcr). But two sub -groups were also divided as Cmax> 25 μg·mL-1 group and Cmax<25 μg·mL-1group. Compared to the two sub-groups, the significant differences were observed in duration therapy,cumulative total dose, and C-reactive protein (CRP). Conclusion There were no significant differences between TDM group and the non-TDM group on the efficacy and safety of vancomycin, but in the TDM group, between Cmax> 25 μg·mL-1 group and Cmax < 25 μg·mL-1group, the efficacy and safety were significantly different. The evidence currently availiable showed that TDM of vancomycin was not necessary only if the steady state concentrations of vaneomycin were maintained in-to a appropriate variation scope.