25mg/kg IV loading dose rounded to nearest 250mg.
15mg/kg IV q8-12h maintenance depending on trough goal.
See VANCOMYCIN DOSING NOMOGRAM under Syndromes
For specific dosing and guidance contact Pharmacy
Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal spp. infections.
1. SCr and urea 2-3 times a week
2. Hydration status
VANCOMYCIN TROUGH CONCENTRATION MONITORING
To be drawn 30 minutes prior to the next dose -- timing dependent upon the following parameters:
Trough concentration recommended if:
- Aggressive therapy (i.e., trough concentration 15-20 mg/L)
- Concomitant nephrotoxin (e.g., aminoglycosides, NSAIDs, amphotericin)
- Serious infection (see below)
- Prolonged course of therapy anticipated (greater than 8 days of therapy)
- Class III Obesity(BMI greater than or equal to 40 kg/m2)
- Unstable Renal Function (either deteriorating or improving)
- Renal dysfunction
- Altered Volume of Distribution
Therapeutic drug monitoring NOT generally required for anticipated short course of therapy (less than equal to 8 days) AND hemodynamically stable and/or surgical prophylaxis.
Goal Trough 15-20 mg/L if treating:
Central nervous system infection
Deep-seated or sequestered infection (e.g., abscess)
MRSA pneumonia, skin and soft tissue infection
Bacteremia due to proven or suspected MRSA or MSSA in penicillin-allergic patient
Other infections due to S.Aureus with Vancomycin MIC greater than or equal to 1 mg/L
Goal Trough 10-15 mg/L if treating:
Skin and Soft tissue infection not due to MRSA
Urinary tract infection
Bloodstream or line infections due to Coagulase Negative Staphylococci (CoNS)
Rash including Stevens-Johnson Syndrome
Red man syndrome (histamine release- slow down infusion)
Aminoglycosides may potentiate nephrotoxicity.
May enhance neuromuscular blockade of NM blocking agents.
Careful with concomitant nephrotoxins.
Target levels vary widely based upon site of infection and organism.
Consult Infectious Diseases or Pharmacy for target recommendations and dosing assistance.
Antimicrobial class: Glycopeptide
Pregnancy category: C
Average serum half life: 8 hours
CSF penetration: Moderate
Biliary penetration: Moderate
Urine penetration: Therapeutic
Lung penetration: Therapeutic
Route of Elimination: Renal