Antimicrobials
Vancomycin

Vancomycin

Dosing

General Information

  • Vancomycin infusion reaction (formerly Red man syndrome)
  • Nephrotoxicity, ototoxicity
  • Cytopenias

Aminoglycosides may potentiate nephrotoxicity

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

  • Confirmed infections with coagulase negative staphylococcus species (e.g. S. epidermidis)
  • Empiric therapy for serious infections potentially due to methicillin-resistant S. aureus (MRSA)
  • Confirmed infection for methicillin-resistant S. aureus (MRSA)
  • Empirically for < 48 hours for suspected/confirmed meningitis until cultures available and re-assess
  • Confirmed infections due to ampicillin-resistant enterococcus

When checking trough level, administer next dose as scheduled. Do not wait for levels to be reported unless otherwise advised.

Serum Level: PRE level 0 to 30 minutes before dose

Initial Level: Prior to fourth or fifth dose

PRE (Trough) levels:

  • 6 - 10 mg/L: Infections (e.g bacteremia) with coagulase negative staphylococci (e.g. S. epidermidis) including line infections.
  • 10 - 15 mg/L: Skin and soft tissue infections (and others) caused by methicillin resistant Staphylococcus aureus (MRSA)
  • Higher levels could be considered in other situations however risk of renal and other toxicity is increased. If prolonged treatment is anticipated, optimization of dosing should be done using AUC/MIC calculations (call ASP pharmacist).

POST (Peak): Not routine. This will be needed if AUC/MIC will be calculated.

Serum creatinine with PRE level once weekly. If targeted levels >10 mg/L, consider more frequent monitoring  Patients recieving > 7 days of therapy should have a weekly CBC to assess for neutropenia.

Concentration: 50 mg/mL

Taste: Metallic taste

Not all strengths of oral liquids are listed nor be available on the CHEO Formulary

  • 125 mg
  • 500 mg

Tablets or capsules are preferred especially over an unpleasant tasting oral liquid.

Not all strengths of oral tablets/capsules are listed and they are not all available on the CHEO Formulary.