15-20 mg/kg q8-12h in patients with normal renal function.
Initial dosing in obese and non-obese patients should be based on actual body weight. Subsequent dosing should be adjusted based on serum trough vancomycin concentrations, renal function and patient specific pharmacokinetic calculations.
Consider more aggressive dosing in serious, invasive infections where a trough level target of 15-20 mg/L is desired (see Monitoring section).
In complicated infections and seriously ill patients, consider a loading dose of 25-30 mg/kg to facilitate rapid attainment of target trough concentrations. Do NOT adjust loading dose for renal dysfunction.
Avoid maintenance doses larger than 2 g; instead consider shorter dosing interval.
Pharmacokinetics may be altered in patients with: burns, critical illness, unstable renal function, morbid obesity, pregnancy, cystic fibrosis.
IV vancomycin is ineffective against the treatment of C. difficile infections. See oral vancomycin monograph for C. difficile treatment.
Consider alternate dosing strategy.