Vancomycin

C. diff Risk

NA

Oral Bioavailability

NA

Approximate Cost

$>4/day (Oral)

Dosing

> 14 days

  • ≤ 28 weeks corrected GA: 20 - 22 mg/kg/dose IV Q18h

  • 29 - 34 weeks corrected GA: 20 - 22 mg/kg/dose IV Q12h

  • ≥ 35 weeks corrected GA: 20 - 22 mg/kg/dose IV Q8-12h

0 - 14 days

  • ≤ 28 weeks GA: 20 - 22 mg/kg/dose IV Q24h

  • 29 – 34 weeks GA: 20 - 22 mg/kg/dose IV Q18h

  • ≥ 35 weeks GA: 20 - 22 mg/kg/dose IV Q12h

General Information

Drug Monitoring

Serum Level: PRE level 0 to 30 minutes before dose

Initial Level: Prior to fourth or fifth dose

PRE (Trough) levels:

  • 6 - 10 mg/L: Infections (e.g bacteremia) with coagulase negative staphylococci (e.g. S. epidermidis) including line infections.

  • 10 - 15 mg/L: Skin and soft tissue infections caused by methicillin resistant Staphylococcus aureus (MRSA)

  • Higher levels or AUC calculations could be considered in other severe infections due to MRSA

POST (Peak): Not routine.

Serum creatinine with PRE level once weekly.
If targeted levels >10 mg/L, consider more frequent monitoring 
Patients recieving > 7 days of therapy should have a weekly CBC to assess for neutropenia.

First Line Indications

  • Confirmed infections with coagulase negative staphylococcus species (e.g. S. epidermidis)

  • Empiric therapy for serious infections potentially due to methicillin-resistant S. aureus (MRSA)

  • Confirmed infection for methicillin-resistant S. aureus (MRSA)

  • Empirically for < 48 hours for suspected/confirmed meningitis until cultures available and re-assess

  • Confirmed infections due to ampicillin-resistant enterococcus

Oral Liquids

Concentration: 50 mg/mL

Taste: Metallic taste

Not all strengths of oral liquids are listed nor be available on the CHEO Formulary

Tablet/Capsule Strengths

  • 125 mg

  •  500 mg

Tablets or capsules are preferred especially over an unpleasant tasting oral liquid.

Not all strengths of oral tablets/capsules are listed and they are not all available on the CHEO Formulary.