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Round all doses to nearest 250mg
Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q24H
Vancomycin 20-25 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
