Loading dose: 25mg/kg IV once
Maintenance dose: 15mg/kg IV q8-12h depending on trough goal
Rounded to nearest 250 mg (suggested maximum of 2500 mg/dose)
Collect trough 0-1h before 3rd or 4th dose.
Target trough 15-20 mg/L for most serious infections, 10-15 mg/L for skin/soft tissue infections or UTI.
If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval
If trough >20, increase dosing interval or decrease dose
Monitor creatinine at least once weekly
Red man syndrome (histamine release- slow down infusion), nephrotoxicity, cytopenias, rash including Stevens-Johnson Syndrome
Aminoglycosides may potentiate nephrotoxicity
May enhance neuromuscular blockade of NM blocking agents
Careful with concomitant nephrotoxins
Antimicrobial class: Glycopeptide
Pregnancy category: C