VANCOMYCIN, IV

• Vancomycin, IV, 30 mg/kg as a loading dose. Follow with 20 mg/kg/dose 12 hourly. Duration depends on the organism & site of infection: for methicillin-resistant Staphylococcus aureus duration is 2 weeks after first negative blood culture, or 4 weeks for complicated infections (e.g. endocarditis).
  • The rate of infusion should not exceed 1 g/hour (i.e. at least 2 hours for a 2 g infusion).
  • Note: Rapid infusion can cause flushing, pain, thrombophlebitis, hypotension and cardiopulmonary arrest.
  • Weigh patients and estimate eGFR (see chapter 7: Nephrological/ urological disorders).
  • See table for dosing interval and measurement of trough concentrations.
  • Aim for trough concentration of 10–20 mcg/mL except in osteitis or endocarditis or if MIC > 1 when trough should be 15–20 mcg/mL.
  • If trough is too low, increase dose (specialist consultation if unsure how much to increase) and/or shorten dose interval to 8 hourly.
  • If trough too high increase dosing interval (specialist consultation if unsure how much to increase).
  • Vancomycin is not significantly removed by conventional intermittent haemodialysis. Dosing and monitoring as for those with eGFR <25 mL/minute.

Dosing intervals and when to measure trough concentrations of vancomycin:

(Adapted with permission from Groote Schuur hospital’s protocol).