Spectrum Of Activity
Pharmacy doses all inpatient vancomycin.
Adjust vancomycin for goal AUC 400-600
Call pharmacy for dosing questions
Order Pharmacist to Dose Vancomycin
May consider load in septic shock patients: 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.
1 year old or olderOrder pharmacist to dose vancomycin 60-80 mg/kg/day divided q6-8 hours
MSSA infections - beta lactams have better outcome data and are preferred for the treatment of MSSA
Suspected or proven MRSA, coagulase-negative Staphylococcal infections, ampicillin resistant Enterococcal infections.
Goal AUC:400-600 Need 2 random vancomycin levels to calculate AUC. Generally draw peak 1 hour after end of infusion, draw trough 30 min before next dose and pharmacist can calculate AUC.
Changing renal function, dialysis or meningitis: Target trough 15-20mcg/mL for most serious infections, 20-25mcg/mL for meningitis.
Nephrotoxicity, especially in presence of other nephrotoxins
Rash including Stevens-Johnson Syndrome
Red man syndrome (histamine release- slow down infusion)
Aminoglycosides, ketorolac and contrast may potentiate nephrotoxicity.
Careful with concomitant nephrotoxins.
Antimicrobial class: Glycopeptide
Pregnancy category: C
Average serum half life: 8 hours
Biliary penetration: Moderate
CSF penetration: Moderate
Lung penetration: Therapeutic
Urine penetration: Therapeutic