Vancomycin (parenteral)

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

$40/day

Dosing

15-20 mg/kg/dose IV q8-12h

Doses be adjusted based on serum drug level monitoring.

Post natal age less than or equal to 14 daysPost natal age greater than or equal to 15 days10-15 mg/kg/dose IV q18h10-15 mg/kg/dose IV q12h

Post natal age less than or equal to 14 daysPost natal age greater than or equal to 15 days10-15 mg/kg/dose IV q12h
10-15 mg/kg/dose IV q8h

Post natal age less than or equal to 7 daysPost natal age greater than or equal to 8 days10-15 mg/kg/dose IV q12h10-15 mg/kg/dose IV q8h

10-15 mg/kg/dose IV q6h

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

General Information

Common Usage

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections

Drug Monitoring

When to check serum levels: Check pre-level at steady state (usually prior to the 4th dose) within 30 minutes before the next dose and with dosage changes, and weekly for courses more than 10 days. Patients with fluctuating renal function or poor therapeutic response may require pre levels more frequently.

Consideration should be given to waiting for the pre-level to be resulted prior to administering the next dose. Turn around time from receipt of the sample in the lab to resulting should be approximately 30 minutes.

Timing of Serum Samples: Pre (trough)-within 30 minutes before the next dose

Target serum levels:

5-15 micrograms/mL for highly susceptible infections ie coagulase negative Staph bacteremia.
10-15 micrograms/mL for MSSA infections and skin and soft tissue infections caused my MRSA
Higher levels could be considered in other situations ie for CNS infections, endocarditis, osteomyelitis and deep seated MRSA infections:Pre (trough) levels greater than 15 micrograms/mL however result in a greater risk for nephrotoxicity and therefore levels should be kept close to 15.

The dosage regimen can be adjusted if serum concentrations are not within the desired ranges. Contact pharmacy if assistance is required.
High Pre:↑ Interval
Low Pre:↓ Interval**
**If dose interval is already q6h then increasing the dose can alternatively be done to increase the pre level into desired range.

Monitor serum creatinine (at baseline and twice weekly) and urine output throughout therapy.
Patients receiving greater than 7 days of therapy should have a weekly CBC to assess for neutropenia.
Use caution and increase monitoring of renal function when used with concomitant nephrotoxins.

Adverse Effects

Red man syndrome (histamine release- slow down infusion), nephrotoxicity, cytopenias.

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

Use caution and increase monitoring of renal function when used with concomitant nephrotoxins.

Pharmacology

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%)