Consult pharmacy for dosing recommendations15-25mg/kg load then 5-10mg/kg IV after each HD
Consult pharmacy for dosing recommendations15mg/kg load then 10mg/kg IV q24h
25-30mg/kg IV loading dose rounded to nearest 250mg (max of 2g per dose).
15mg/kg IV q8-12h maintenance depending on trough goal.
PreparationDosingVancomycin 2500mg in 500mL NS (5mg/mL)30-50 mg/kg/24hr (1.25-2 mg/kg/hr)
Expiration 48 hoursRoom temperature
Antimicrobial Stewardship approved criteria must be indicated at ORDER ENTRY.
Treatment in response to SINGLE blood culture positive for coagulase negative staphylococcus, if other blood cultures drawn in same time frame are negative
Treatment of infections due to β-lactam sensitive bacteria in patients with renal failure chosen for dosing convenience
Eradication of MRSA colonization
Primary treatment of antibiotic-associated colitis
Selective decontamination of the digestive tract
Routine surgical prophylaxis other than in a patient with life-threatening allergy to β-lactam antibiotics
Collect trough 0-1h before 3rd dose if abnormal/fluctuating renal function.
Target trough 15-20mcg/mL for most serious infections, 20-25mcg/mL for meningitis
If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval
If trough >20, increase dosing interval or decrease dose
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.
-Treatment of serious infections due to β-lactam resistant Gram positive microorganisms documented by cultures
- For methicillin sensitive coagulase positive Staphylococci, nafcillin is the drug of choice
Treatment of infections due to Gram positive microorganisms in patients with history of serious type I allergy to β-lactam antimicrobials when other agents are not adequate
Treatment of antibiotic-associated colitis when it fails to respond to metronidazole, is severe and potentially life-threatening, or occurs in setting in which metronidazole cannot be used
Prophylaxis for endocarditis as recommended by the American Heart Association, specifically genitourinary and gastrointestinal procedures in moderate to high risk patients allergic to ampicillin/amoxicillin
Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices
Empiric therapy of unexplained fever in neutropenic patients who have severe mucositis, previous quinolone prophylaxis, known colonization with MRSA or PRSP, clinically obvious catheter related infection or hypotension
Empiric therapy for sepsis in patients with indwelling intravascular catheters or for life-threatening infections likely to involve MRSA, MRSE or PRSP
Antimicrobial class: Glycopeptide
Pregnancy category: C
Average serum half life: 8 hours
Biliary penetration: Moderate
CSF penetration: Moderate
Lung penetration: Therapeutic
Urine penetration: Therapeutic