Dosing
| CrCl (mL/min) | Vancomycin Dosing |
|---|---|
| > 70 mL/min | 15 mg/kg every 8-12 hours |
| 40 – 69 mL/min | 15 mg/kg every 12-24 hours |
| 20 – 39 mL/min | 15 mg/kg every 24-48 hours |
| <20 mL/min | 15 mg/kg x 1, then re-dose by level |
| HD/CAPD | 15 mg/kg x 1, then re-dose by level |
| CVVH | 1 g IV every 24 hours |
Doses are based on actual body weight
Doses should be rounded to the nearest 250 mg (maximum 2 g per dose)
Consultation with an Infectious Disease specialist is strongly recommended for Staphylococcus aureus bacteremia (irrespective of source and susceptibilities)
Am J Health-Syst Pharm. 2009; 66:82-98
Monitoring
Trough serum concentrations are the most accurate and practical method for monitoring efficacy and avoiding adverse effects
Troughs should be obtained just prior to the next dose when patient at steady-state (usually before 4th or 5th dose)
Minimum serum trough levels should always be maintained >10mg/L
Minimum serum trough levels of 15-20 mg/L are recommended for complicated infections (endocarditis, osteomyelitis, meningitis, and staphylococcal pneumonia)