Spectrum: Local Antimicrobial Stewardship, for Island Health

101-120 mcmol/L High Trough

Round all doses to nearest 250mg

Age 20-39

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

Age 40-49

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 50+

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