Vancomycin (parenteral)

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

$40/day

Dosing

General Pediatric

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

Adult

15-20 mg/kg/dose IV q8-12h

Renal

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

General Information

Common Usage

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

Drug Monitoring

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.

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

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

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