General dosingMild to Moderate InfectionsSevere Infections (sepsis, osteomyelitis), Meningitis (< 6 mo. of age)Meningitis (6 mo. of age and older)Infants and children: 60 mg/kg/DAY IV divided q6-8h; maximum 4 g/DAY
(q6h interval is preferred unless patient has active renal impairment)
Adjust dose based on serum drug concentration - see drug monitoring section for details. 40-60 mg/kg/DAY IV divided q6-8h60 mg/kg/DAY IV divided q6-8h80 – 100 mg/kg/DAY IV divided q6-8h
Less than 29 weeks corrected GA29 to 34 weeks corrected GAGreater than 34 weeks corrected GA15-24mg/kg/DAY IV divided q24h20-22mg/kg/DAY IV divided q12-18h40-45mg/kg/DAY IV divided q12h
Less than 29 weeks corrected GA29 to 34 weeks corrected GA34 to 38 weeks corrected GA26-30mg/kg/DAY IV divided q24h40-45mg/kg/DAY IV divided q12h40-45mg/kg/DAY IV divided q8h
38 to 46 weeks corrected GA40-60mg/kg/DAY IV divided q8h
No dosage adjustment required
Consult a pharmacist for renal dosing.
Renally cleared, requires dosage adjustment with changes in renal function.
Hemodialysis: Administer dose following dialysis treatment
CRRT: Clearance of vancomycin dependent upon method of renal replacement, filter type and flow rate
Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections
Consult pharmacy for drug monitoring and interpretation as dosing is highly patient specific
When to check serum concentrations:
Check pre-concentration: 0-1 hours before dose
Initial concentration: prior to 3rd-4th dose for neonates and 5th-6th dose for infants/children
Subsequent concentrations: once weekly for courses more than 7 days (twice weekly if receiving other nephrotoxic agents, elevated baseline serum creatinine, or pre-dose serum concentration target greater than 15mg/L)
Pre-dose serum concentrations:
Target 7-12 mg/L: bacteremia including infections with coagulase negative staphylococci (e.g. S. epidermidis), skin or soft tissue infections caused by methicillin resistant Staphylococcus. aureus (MRSA; MIC less than 1 mcg/mL), or line infections
Target 12-15 mg/L: suspected or documented bacterial meningitis sepsis, deep, severe soft tissue infections, pneumonia, osteomyelitis
Target 15-20 mg/L: RARELY indicated in children due to lack of clinical evidence of efficacy. Consider for infective endocarditis or infections with vancomycin sensitive organisms that fail therapy at lower pre-dose serum concentration
Monitor urine output daily and serum creatinine and CBC (to assess for neutropenia) weekly with pre-dose concentration.
Red man syndrome (histamine release - slow down infusion), nephrotoxicity, cytopenias.
Management: Slow infusion to infuse over 120 minutes. Pre-dose with Diphenhydramine IV 0.5mg/kg/DOSE.
Aminoglycosides may potentiate nephrotoxicity.
Use caution and increase monitoring of renal function when used with concomitant nephrotoxins.
Antimicrobial class: Glycopeptide
Average serum half life:
Newborns: 6 to 10 hours
Infants and Children 3 months to 4 years: 4 hours
Children and Adolescents >3 years: 2.2 to 3 hours
Route of Elimination: Primarily via glomerular filtration; excreted as unchanged drug in the urine (80% to 90%)