Vancomycin IV

C. difficile 위험도


1 g IV q12h 500 mg IV q6h

  • Age <1w 10 mg/kg IV q12h

  • Age 1w-1m 10 mg/kg IV q8h

  • Age >1m 10 mg/kg IV q6h

No dose adjustment

CrCl 110CrCl 90-100CrCl 80CrCl 60-70CrCl 40-50CrCl 30CrCl 20CrCl 10HDCAPD1.5 g IV q12h1.25 g IV q12h1 g IV q12h750 mg IV q12h500 mg IV q12h750 mg IV q24h500 mg IV q24h500 mg IV q48h1 g IV q7d0.5-1 g IV q7d

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

If trough low, increase dose (do not exceed 2 g/dose) OR decrease dosing interval.

If trough >20, increase dosing interval or decrease dose.


  • Hypokalemia

  • Abdominal pain

  • Diarrhea

  • Nausea

  • Vomiting


  • Cardiac arrest

  • Hypotension

  • Clostridium difficile diarrhea

  • Agranulocytosis

  • Neutropenia

  • Thrombocytopenia

  • Anaphylaxis

  • Drug reaction with eosinophilia and systemic symptoms

  • Ototoxicity

  • Nephrotoxicity

  • Piperacillin

  • Tobramycin

  • Gentamicin

  • Amikacin

  • Cholera vaccine, live

  • 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

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic


  • Caution in patients with renal insufficiency due to increased risk for nephrotoxicity and ototoxicity with IV administration.

  • Discontinue use at the first appearance of signs and symptoms of dermatologic reaction.

  • Monitoring recommended with oral therapy and dose adjustments recommended with IV administration in elderly patients.

  • Infusion-related reactions, including hypotension and cardiac arrest, may occur; administer in dilute solution over at least 60 minutes and stop infusion if reaction occurs.

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