Spectrum: Local Antimicrobial Stewardship, for Saskatchewan Health Authority - Saskatoon Area

40-60 micromol/L

Round all doses to nearest 250mg

Age 20-39

Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q8H

Age 40-69

Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q12H

Age 70-79

Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q18H

Note

In elderly patients (age > 60) with low muscle mass, use clinical judgement as SCr may not reflect renal function accurately