Vancomycin IV

C difficile risk
Low
Oral Bioavailability
N/A

Dosing

Use actual body weight to calculate doses. 25 mg/kg IV loading dose then 15 mg/kg IV q8h (for patients with normal renal function).

Consult pharmacy if impaired renal function.

For patients allergic to penicillin AND cefazolin only.1 g IV q12h until delivery

IV

5 mg/mL

Supplied by Pharmacy

24H Refrigerate

Consult pharmacy in patients with renal impairment.

Infants with HIE or Renal ImpairmentIn infants with impaired renal function and those with moderate to severe HIE receiving induced hypothermia give an initial dose of 15 mg/kg x 1 dose then order 2 post dose levels. Consult with NICU pharmacist for timing of levels

General Information

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections Intrapartum GBS prophylaxis in patients with allergies to both penicillin and cefazolin.

Pregnancy: Compatible.

Breastfeeding: Compatible.

Consult pharmacy for all patients on vancomycin for level monitoring and dose adjustment.

Serum trough levels should be routinely done in pregnant patients on vancomycin. Due to the altered pharmacokinetic parameters in pregnancy, peak levels may need to be drawn to more accurately predict appropriate patient dose and interval. Consult pharmacy.

Measure trough level at steady state before 3rd - 4th dose for most patients.

Target trough 15 - 20 mg/L for most serious infections including MRSA, 10 - 20 mg/L for less serious infections (UTI, SSTI)

Monitor trough weekly to ensure within therapeutic range.

Monitor serum creatinine at least twice weekly. Monitor urine output.

In non pregnant individuals, can use standard vancomycin dosing nomograms based on age, Scr, and target vancomycin level. Consult pharmacy for assistance.

Vancomycin Infusion Reaction (histamine release - slow down infusion rate), nephrotoxicity, cytopenias, rash including Stevens-Johnson Syndrome

Additive nephrotoxicity with concomitant nephrotoxins (ie. NSAIDs, piperacillin/tazobactam, aminoglycosides) May enhance neuromuscular blockade of NM blocking agents

Antimicrobial class: Glycopeptide.

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