Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

Dosing

25mg/kg IV loading dose rounded to nearest 250mg

15mg/kg IV q8-12h maintenance depending on trough goal (see vancomycin dosing nomogram under Syndromes)

General Information

Common Usage

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections

Drug Monitoring

Serum trough levels should ONLY be ordered in the following situations:
patient is at risk of accumulation, OR receiving other nephrotoxic drugs, OR serum creatinine is above normal/fluctuating, OR patient is obese/pregnant, OR a higher level of 15-20mg/L is desired

Measure trough level at steady state before 4th dose for most patients, but if abnormal/fluctuating renal function then measure before 3rd dose.

Target trough 15-20mcg/mL for most serious infections, 10-20mcg/ml for less serious infections (UTI, SSTI)

See Vancomycin Nomogram under Syndromes for dosing information

Monitor trough weekly to ensure within therapeutic range

Monitor creatinine at least twice weekly

Adverse Effects

Red man syndrome (histamine release- slow down infusion rate), nephrotoxicity, cytopenias, rash including Stevens-Johnson Syndrome

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Additive nephrotoxicity with concomitant nephrotoxins

Pharmacology

Antimicrobial class: glycopeptide

Pregnancy category: C

Average serum half life: 8.0

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic