This nomogram is only valid for patients weighing less than 125 Kg and with a serum creatinine less than 200 mcmol/L
Maximum loading dose is 3000 mg and maximum starting maintenance dose is 2000 mg.
Consider trough before 3rd dose as pharmacokinetics are difficult to predict in this population.
Clinical Pharmacy and/or ID consult is strongly recommended.
Consider a loading dose of 20-25 mg/kg and consult clinical pharmacy for recommendations for follow up serum concentrations and maintenance dosing.
High Target Trough Level
Central nervous system infection
Deep-seated or sequestered infection (e.g., abscess)
MSSA bacteremia (with severe penicillin allergy)
Septic Native Joint Arthritis
Low Target Trough Level
Skin and soft tissue infection
Urinary tract infection