II. Indications
III. Mechanism
IV. Dosing: IV Vancomycin
- Child
- Infuse each dose over 1 to 2 hours
- Load: 15 mg/kg IV for first dose
- Next: 10 mg/kg/dose IV every 6 hours
- Dose every 8 hours if age 1 week to 1 month
- Dose every 12 hours if age <1 week old
- Adult
- Dose: 15 to 20 mg/kg IV every 8 to 12 hours
- Consider loading first dose at 25 to 30 mg/kg IV in severe infections
- Adjust dosing intervals in reduced Renal Function
- General
- Infuse dose over 1 hour (over 1.5 to 2 hours if dose >1 gram)
- Monitor drug levels or limit to maximum dose of 2 g/day
- Consider dosing in 250 mg increments
- Standard 1 gram IV (over 1-2 hours) every 12 hours is only the dose for a 70 kg patient
- Dose is based on absolute body weight (adjust with trough levels in obese patients)
- This standard dose will be inadequate for a heavier patient
- Dose: 15 to 20 mg/kg IV every 8 to 12 hours
V. Dosing: Oral Vancomycin (Firvanq) for Clostridium difficile
- Second-line agent in Clostridium difficile (Pseudomembranous colitis)
- Adult Dose
- Take 125 mg orally divided four times daily
- Child Dose
- Give 40 mg/kg/day orally divided four times daily
- Newborn Dose
- Give 10 mg/kg/day orally divided four times daily
VI. Adverse Effects
- See Glycopeptide Antibiotic
-
Red Man Syndrome
- Infuse slowly
- Consider premedication with Antihistamines
- Phlebitis
- With extravasation
- End organ toxicity
- Neutropenia (reversible)
- Ototoxicity
- Nephrotoxicity
- Increased risk of Acute Kidney Injury when combined with Piperacillin-tazobactam
- Monitor Renal Function
VII. Safety
- Safe in Pregnancy
- Safe in Lactation
VIII. Pharmacokinetics: Goal Levels
- Peak Levels: 20-50 mg/L (not recommended for drug monitoring)
- Monitor with trough levels drawn immediately before next dose (after fourth dose)
- Target Trough level: >10 mg/L (15 to 20 mg/L in complicated infections)
IX. Precautions
- Infuse slowly over 1-2 hours
- Indications to Monitor levels
- High dose Vancomycin (>2 grams per day)
- Renal Insufficiency or Renal Failure
- Vancomycin is a large molecule that crosses the blood-brain barrier
X. Resources
XI. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Lacy (2000) Drug Information Handbook, Lexi-Comp
- (2014) Presc Lett 21(8): 43
Images: Related links to external sites (from Bing)
Related Studies
| vancomycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VANCOMYCIN HCL 125 MG CAPSULE | Generic | $1.40 each |
| VANCOMYCIN HCL 250 MG CAPSULE | Generic | $1.98 each |
| firvanq (on 10/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FIRVANQ 50 MG/ML SOLUTION | $0.94 per ml | |