Antimicrobials
Vancomycin IV

Vancomycin IV

None
N/A

Dosing

General Information

Preparation

  • Reconstitute vials with a compatible diluent to a final concentration of 50 mg/ml. (10 g bulk vials may be reconstituted to a final concentration of 100 mg/ml)
  • Reconstituted solution must be further diluted with at least 100 ml of a compatible diluent per 500 mg of vancomycin prior to administration.

Administration

  • Recommended infusion period of at least 30 minutes for every 500 mg administered.

Diluent

  • D5W, D5NS, LR, D5LR, NS

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections.

Tier 2 Protected Antimicrobial

  • Broad spectrum, but 1st line for common infections, comes with a high risk of poor stewardship if initial workup and follow-up are not in place

Strategies Used:

  1. Appropriate workup initially
  2. Pharmacists audit/de-escalate
  3. Set EBM Duration

Monitoring AUC

  • Two random serum vancomycin concentrations are used to monitor
  • Random levels should be ordered ≥2 hours after infusion has ended and 1 hour prior to the next dose.
  • Two levels can be ordered at any-time during the dosing interval, results may not be as accurate.
  • Random vancomycin levels should be maintained at > 10 mcg/ml to avoid development of resistance.

Vancomycin levels are warranted in the following indications if

  • SSTI/UTI: vancomycin continues for >5days, acute kidney injury or signs of nephrotoxicity
  • Meningitis: draw at steady state
  • All other indications: draw at steady state
  • Unless: maintenance dose >4gm/day, steady state reached >4days, renal transplant, or IV transplant <72 hours. Then may draw two levels after the first maintenance dose

Repeat trough monitoring is recommended for patients

  • AUC dosing: Repeat level every 5-7 days unless clinical picture dictates. Adjust dose to goal level.
  • Meningitis: Repeat trough levels every 5-7 days or as clinically necessary

Basic Metabolic Panel

  • Daily BMP should be drawn on patients receiving IV vancomycin.

Microbiology Monitoring

  • Bacterial cultures with sensitivities and a CBC should be repeated during therapy if the patient is not improving
  • If culture results are negative or vancomycin-resistant organisms are present, vancomycin therapy should be stopped immediately to prevent the further development of resistance
  • 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

Vancocin