Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

$40/day

Dosing

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

Usual starting dose: Infants and children: 60 mg/kg/DAY IV divided q6-8h; usual maximum starting dose 4 g/DAY.

Dose should then be adjusted based on serum drug level monitoring.

General Information

Common Usage

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

Drug Monitoring

When to check serum levels: Check pre-level 0-1 hours before 3rd-4th (neonates) or 5th-6th (infants/children) dose, with dosage changes, and weekly for courses more than 10
days.

Target serum levels: 15 to 20 mg/L for CNS infections and MRSA infections. 10 to 20 mg/L for all other infections and empiric therapy.

Monitor serum creatinine and urine output throughout therapy.

Adverse Effects

Red man syndrome (histamine release - slow down infusion), nephrotoxicity, cytopenias.

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

Use caution and increase monitoring of renal function when used with concomitant nephrotoxins.

Pharmacology

Antimicrobial class: glycopeptide

Average serum half life: Newborns: 6 to 10 hours.
Infants and Children 3 months to 4 years: 4 hours.
Children and Adolescents >3 years: 2.2 to 3 hours

Route of Elimination: Primarily via glomerular filtration; excreted as unchanged drug in the urine (80% to 90%)