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Round all doses to nearest 250mg
Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q12H
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
Vancomycin 25 mg/kg loading dose then 15 mg/kg maintenance dose Q18H
In elderly patients (age > 60) with low muscle mass, use clinical judgement as SCr may not reflect renal function accurately
