Antimicrobials
Vancomycin IV

Vancomycin IV

None
N/A

Dosing

General Information

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

Pregnancy: Compatible.

Breastfeeding: Compatible.

Order vancomycin troughs only if the patient meets the following criteria:

  1. Vancomycin treatment duration is expected to be greater than 7 days, where baseline and ongoing TDM may be indicated (e.g. MRSA bacteremia, infective endocarditis, osteomyelitis, septic arthritis)

OR

  1. Empiric vancomycin therapy is not likely to be discontinued within 72 hours AND one or more of the following:
    • Patient receiving aggressive dosing (where trough concentration is anticipated to be greater than 15 mg/L)
    • Renal function unstable, serum creatinine increased by 30 umol/L or 1.5 times baseline
    • Patient on dialysis
    • Patient receiving concurrent nephrotoxic or ototoxic drugs
    • Patient with altered volume of distribution or clearance, including:
      • Age 65 years or greater
      • Hypermetabolic (e.g. burn patient, cystic fibrosis)
      • Low body weight / muscle mass or frail
      • Obese (125% of ideal body weight or greater)
      • Pregnant
      • Septic shock
    • Patient not responding to therapy

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 10-15 mg/L.

See Vancomycin Nomogram under Syndromes for dosing information.

Monitor trough weekly to ensure within therapeutic range.

Monitor creatinine at least twice weekly.

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

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Additive nephrotoxicity with concomitant nephrotoxins

Antimicrobial class: Glycopeptide

Average serum half life: 8.0

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic