40-60 mg/kg/24h IV divided q6-8h
Maximum: 4 g/ 24 h prior to levels.
Dose should then be adjusted based on serum drug level monitoring
15-20 mg/kg/dose IV q8-12h
Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.
Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections
When to check serum levels: Only check level for patients in whom it is anticipated that they will be requiring therapy with vancomycin for longer than 48 hours. Check pre-level at steady state (usually prior to the 4th dose) within 30 minutes before the next dose and with dosage changes, and weekly for courses more than 10 days
Target serum levels: 15 to 20 micrograms/L for CNS infections, endocarditis, osteomyelitis and MRSA infections. 5-15 micrograms/L for highly susceptible infections ie coagulase negative Staph bacteremia. 10-20 micrograms/L for MSSA infections
Monitor serum creatinine and urine output throughout therapy.
Red man syndrome (histamine release- slow down infusion), nephrotoxicity, cytopenias.
Aminoglycosides may potentiate nephrotoxicity
Use caution and increase monitoring of renal function when used with concomitant nephrotoxins.
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%)