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

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