Spectrum: Local Antimicrobial Stewardship, for Island Health

Vancomycin Nomogram

This nomogram is only valid for patients weighing less than 125 Kg and with a serum creatinine less than 200 mcmol/L

Patients >125 Kg

Maximum loading dose is 3000 mg and maximum starting maintenance dose is 2000 mg.

Consider trough before 3rd dose as pharmacokinetics are difficult to predict in this population.

Clinical Pharmacy and/or ID consult is strongly recommended.

Patients with SCr >200 mcmol/L or on Dialysis

Consider a loading dose of 20-25 mg/kg and consult clinical pharmacy for recommendations for follow up serum concentrations and maintenance dosing.

Select Desired Serum Trough Level Based on Clinical Indication

High Target Trough Level
(15-20 mg/L)

Indications

  •  Bacteremia

  •  Central nervous system infection

  •  Deep-seated or sequestered infection (e.g., abscess)

  •  Endocarditis

  •  MRSA pneumonia

  •  MSSA bacteremia (with severe penicillin allergy)

  •  Osteomyelitis

  •  Septic Native Joint Arthritis

Low Target Trough Level
(10-15mg/L)

Indications

  •  Skin and soft tissue infection

  •  Urinary tract infection