25-30 mg/kg IV loading dose rounded to nearest 250mg (max of 2g per dose)
15 mg/kg IV q8-12h maintenance depending on trough goal
eGFR 0 - 10 eGFR 10 - 50 eGFR > 5025-30 mg/kg (max 2 g/dose) first dose then 7.5 mg/kg IV q48-72h25-30 mg/kg (max 2 g/dose) first dose then 15 mg/kg IV q24-96h25-30 mg/kg (max 2 g/dose) first dose then 15-30 mg/kg IV q8-12h
15-25 mg/kg load then 5-10 mg/kg IV after each HD
Monitoring required
15 mg/kg load then 10 mg/kg IV q24h
Monitoring required
Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections.
Collect trough 0-1h before 3rd dose if abnormal/fluctuating renal function.
Target trough 15-20 mcg/mL for most serious infections, 20-25 mcg/mL for meningitis.
If trough low, increase dose (do not exceed 2 g/dose) OR decrease dosing interval.
If trough >20, increase dosing interval or decrease dose.
Nephrotoxicity
Cytopenias
Rash including Stevens-Johnson Syndrome
Red man syndrome (histamine release - slow down infusion)
Aminoglycosides may potentiate nephrotoxicity.
May enhance neuromuscular blockade of NM blocking agents.
Careful with concomitant nephrotoxins.
Antimicrobial class: Glycopeptide
Pregnancy category: C
Average serum half life: 8 hours
Urine penetration: Therapeutic
Lung penetration: Therapeutic
CSF penetration: Moderate
Biliary penetration: Moderate
