Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Spectrum Of Activity

Dosing

Refer to Vancomycin Nomogram

Rounded to nearest 250 mg (suggested maximum of 2500 mg/dose)

Please refer to Vancomycin Nomogram

0 - 70 kg70+ kgLoading dose: 25 mg/kg IV onceMaintenance dose:
500 mg IV qHD750 mg IV qHD

Intravenous
Loading dose: 20 mg/kg IV once
Maintenance dose: 20 mg/kg IV q4-7 days (monitor trough levels)

Intraperitoneal
Loading dose: 30 mg/kg IP once
Maintenance dose: 30 mg/kg IP q5-7 days

General Information

Adverse Effects

Red man syndrome (histamine release- slow down infusion), nephrotoxicity, cytopenias, rash including Stevens-Johnson Syndrome

Drug Monitoring

Collect trough 0-1h before 3rd or 4th dose.

Target trough 15-20 mg/L for most serious infections, 10-15 mg/L for skin/soft tissue infections or UTI.

If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval

If trough >20, increase dosing interval or decrease dose

Monitor creatinine at least once weekly

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Careful with concomitant nephrotoxins

Pharmacology

Antimicrobial class: Glycopeptide

Pregnancy category: C