Spectrum: Local Antimicrobial Stewardship, for Island Health

121-140 mcmol/L High Trough

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+

Vancomycin 25 mg/kg loading dose

Contact clinical pharmacist for assistance in maintenance dosing; likely empiric maintenance dose of 15 mg/kg Q24H

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