Vancomycin IV

C difficile risk
Oral Bioavailability


25-30mg/kg IV loading dose rounded to nearest 250mg (max of 2g per dose).

15mg/kg IV q8-12h maintenance depending on trough goal.

eGFR 0 - 10 eGFR 10 - 50 eGFR > 5025-30mg/kg (max 2g/dose) first dose then 7.5mg/kg IV q48-72h25-30mg/kg (max 2g/dose) first dose then 15mg/kg IV q24-96h25-30mg/kg (max 2g/dose) first dose then 15-30mg/kg IV q8-12h

15-25mg/kg load then 5-10mg/kg IV after each HD

Monitoring required

15mg/kg load then 10mg/kg IV q24h

Monitoring required

General Information

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

Collect trough 0-1h before 3rd dose if abnormal/fluctuating renal function.

Target trough 15-20mcg/mL for most serious infections, 20-25mcg/mL for meningitis

If trough low, increase dose (do not exceed 2g/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

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