Table of Contents

VANCOMYCIN EMPIRIC DOSING GUIDELINES 

TABLE 1 INITIAL DOSE PER INTERVAL

TOTAL BODY WEIGHT (kg) LOADING DOSE (mg) MAINTENANCE DOSE (mg)
40-60 1000 750
61-80 1250 1000
81-100 1500 1250

 TABLE 2 INITIAL DOSING INTERVAL (hours) 

Serum Creatinine (umol/L)

Age Group (years)

20-29

30-39

40-49

50-59

60-69

70-79
40-60 8 12 12 12 12 18
61-80 12 12 12 12 18 18
81-100 12 12 12 18 18 18
101-120 12 12 18 18 18 24
121-140 12 18 18 18 24 *
141-160 18 24 24 24 * *
161-180 24 24 * * * *
181-200 24 * * * * *

*Patients with significant renal impairment should receive a loading dose followed by 3 and 24 hour post dose serum levels.  Contact a regional clinical pharmacist for assistance with interpretation of pre steady-state serum levels. 

KEY

1.   Establish patient age, weight and serum creatinine concentration.

2.   Using Table 1, identify initial loading dose and maintenance dose per interval according to patient weight.

3.   Using Table 2, identify initial dosing interval according to patient age and serum creatinine.

4.   Doses over 1250mg should be infused over 90 minutes.

5.   Serum levels should be performed within 72 hours of initial dose.

 FOOTNOTES

1.   These dosage guidelines are derived from literature recommendations and Pharmacokinetic Service data.  The guidelines are intended to be used for the estimation of an appropriate INITIAL EMPIRIC DOSAGE REGIMEN to achieve serum levels in the range of 5-15mg/L (pre) and 15-30mg/L (3 hour post; calculated Cpmax of 20-40mg/L).  More aggressive dosing may be required to obtain vancomycin pre levels 15-20mg/L. 

These guidelines are NOT A SUBSTITUTION FOR SERUM DRUG LEVEL MONITORING. Serum drug level monitoring should be undertaken within 72 hours of initial empiric dose to ensure drug concentrations are within the normal therapeutic range.