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

121-140 micromol/L

Round all doses to nearest 250mg

Age 20-29

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

Age 30-69

Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q18H

These patients have unstable and/or reduced renal function and the nomogram may not be as predictive

Age 70-79

Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q18-24H

These patients have unstable and/or reduced renal function and the nomogram may not be as predictive

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

Age 80-89

Vancomycin 25 mg/kg loading dose

Contact clinical pharmacist for assistance

These patients have unstable and/or reduced renal function and the nomogram may not be as predictive

Note

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