Spectrum: Local Antimicrobial Stewardship, for Eastern Health

141-160 mcmol/L

This nomogram is for the calculation of initial MAINTENANCE dose for patients with stable renal function. Dose should be adjusted as required based on vancomycin trough levels.

If required, LOADING dose (x1) is as follows:

  • 40-50 kg : 1250 mg

  • 51-60 kg: 1500 mg

  • 61-70 kg: 1750 mg

  • 71-80 kg: 2000 mg

  • 81-90 kg: 2250 mg

  • 91 kg or more: 2500 mg

Age 20-49

Q18H based on Actual body weight:

40-50 kg = 750 mg
51-70 kg = 1000 mg
71-90 kg = 1250 mg
91 kg or more: 1500 mg

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

Age 50-59

Q18-24H based on Actual body weight

40-50 kg = 750 mg
51-70 kg = 1000 mg
71-90 kg = 1250 mg
91 kg or more: 1500 mg

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 60-69

Q24H based on Actual body weight:

40-50 kg = 750 mg
51-70 kg = 1000 mg
71-90 kg = 1250 mg
91 kg or more: 1500 mg

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

Age 70-89

Antipated dosing interval q24h or longer based on Actual body weight: Pharmacist consult recommended

40-50 kg = 750 mg
51-70 kg = 1000 mg
71-90 kg = 1250 mg
91 kg or more: 1500 mg

Contact clinical pharmacist for assistance

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

Note

In elderly patients (age > 60) with low muscle mass, use clinical judgement as SCr may not reflect renal function accurately