Adults

Recommended Initial Dose and Dosing Interval

Dose

• recommended in:
  • severe infections where rapid attainment of target trough level is desired, e.g. vertebral osteomyelitis, MRSA pneumonia, epidural abscess, septic shock
  • patients with significant renal dysfunction in order to decrease time to target trough level
• 25-30mg/kg (based on actual body weight (ABW); maximum dose 3000mg) single dose followed by maintenance dose (separated by dosing interval as recommended in the dosing interval chart below).

• 15mg/kg (based on ABW)/dose (maximum of 2g/dose)
  • Doses > 500mg - round to nearest 250mg
  • Doses < 500mg - round to nearest 50mg

• Peritoneal dialysis (PD) or low flux intermittent hemodialysis (IHD) – consider loading dose of 25-30 mg/kg. Subsequent doses should be based on vancomycin levels and usually given every 7-10 days.

• High flux IHD – consider loading dose of 25-30mg/kg (maximum of 2g/dose). Subsequent maintenance dose (infused in the last 60-120 minutes of each dialysis run):

  • patient weight ≤ 60kg: 500mg

  • patient weight 61-100kg:  750mg

  • patient weight > 100kg:  1000mg

      Adjustment of high flux IHD dose based on pre-3rd maintenance dose level (drawn prior to/at the start of dialysis run):

• • < 15 mg/L – increase dose by 250mg

  • 15-20 mg/L – continue same dose.  Monitor level at least weekly.

  • 20-25 mg/L – decrease dose by 250mg

  • > 25 mg/L – hold and contact MRHP

• Administration:
  • ≤ 1g – infuse over 60 minutes
  • > 1g – 1.5g – infuse over 90 minutes
  • > 1.5g – infuse over 120 minutes

Dosing interval

• Calculated creatinine clearance (mL/min)
  
  • Clcr (females) = [(140 - age) x IBW] divided by Scr (µmol/L)
  • Clcr (males) = Clcr (females) x 1.2