Vancomycin for Serious Infections

                             

                                  Vancomycin for Serious Infections

• ·         Sepsis/bacteremia
•       Endocarditis
•       Health care associated pneumonia
•       Community acquired MRSA pneumonia
•        Meningitis

Loading dose = 30 mg/kg ( use 20 mg/kg if CKD)

Administration Guidelines:

·         Dosing based on actual body weight ( including obese patients)

·         Max initial dose = 2000 mg

·         Standard rate of administration: 1000 mg over 60 minutes

Loading dose of Vancomycin

Weight	Loading Dose	Infusion Rate
25-35 kg	750 mg	60 min
36-45 kg	1000 mg	60 min
46-55 kg	1250 mg	90 min
56-65 kg	1500 mg	90 min
66-75 kg	1750 mg	120 min
≥ 76 kg	2000 mg	120 min

For the seriously iII septic patients

       

Maintenance dose of Vancomycin

Creatinine Clearance (mL/min)	Dosage & Frequency                 Total body weight (TBW)	Timing Trough Level
>50	15-20 mg/kg Q 8-12H	Before 4th or 5th dose
30-49	15-20 mg/kg Q 12-24H	Before 3rd or 4th dose
15-29	10-15 mg/kg Q 24H	Before 3rd dose
Hemodialysis	Load: 20-25 mg/kg x 1 Maintenance: 10-15 mg/kg post-dialysis when levels <15mg/L or <20 mg/L in severe infections	1.Pre-dialysis-Assumes that HD is high flux per 3h session 2.Alternative: 4h after completion of dialysis session
CRRT	Load: 20-25 mg/kg x 1 Maintenance: 10-15 mg/kg Q 24H	Before 3rd or 4th dose

Therapeutic drug monitoring

Goal Troug (mcg/mL)	Indication
10-15	Cellulitis, skin/soft tissue infections
15-20	Pneumonia, bacteremia, endocarditis, osteomyelitis

Recommend trough levels >10 mcg/mL to avoid microbial resistance