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

81-100 micromol/L

Round all doses to nearest 250mg

Age 20-59

Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q12H

Age 60-69

Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q12-18H

If more aggressive therapy is desired, select more frequent dosing interval

Age 70-89

Vancomycin 25 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