Vancomycin IV - Renal Dosing

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

If worsening renal function, actual GFR is likely lower than calculated.

If improving renal function, actual GFR is likely higher than calculated eGFR.

eGFR 0-10

25mg/kg IV first dose then dosing as per random concentrations

For specific dosing and guidance contact Pharmacy

eGFR 10-50

25mg/kg IV first dose then 15mg/kg IV with interval determined by dosing nomogram

For specific dosing and guidance contact Pharmacy

eGFR > 50

25mg/kg IV first dose then 15mg/kg IV q8-12h with interval determined by dosing nomogram

For specific dosing and guidance contact Pharmacy

Loading dose:

25mg/kg IV once then as per below

Maintenance dose:

Less than or equal to 100kg:
750 mg IV qHD (given during last hour of HD session)

Greater than 100kg:
1000mg IV qHD (given during last hour of HD session)

For specific dosing and guidance contact Pharmacy

15mg/kg load then 7.5-10mg/kg IV q12h

For specific dosing and guidance contact Pharmacy

Intraperitoneal Treatment of Peritonitis

The on-call peritoneal dialysis nurse will determine initial dose of vancomycin and administer to the patient. Ward nurses do not administer intraperitoneal doses of medication (exception: 6th medicine, SPH).

Contact the PD pharmacist for advice on drawing drug concentrations & subsequent dosage adjustments

Intravenous Administration for a Systemic Infection

25mg/kg IV x 1 dose then 15mg/kg administered once serum concentration close to desired therapeutic range

For specific dosing and guidance contact Pharmacy