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For patients where renal toxicity may be a concern, alternative to Vancomycin is Clindamycin 900 mg IV re-dosed q6h
The initial dose of Vancomycin is 20 mg/kg IV. Re-dose as 15 mg/kg IV. Round dose to the nearest 250 mg
The initial dose of Gentamicin is 5 mg/kg IV (round dose to the nearest 50 mg). Re-dose as 2 mg/kg IV rounded off to the nearest 20 mg.
Gentamicin dosing should be based on actual body weight unless obese (actual weight greater than 130%
above ideal body weight).
In obese patients, use an adjusted body weight.
Ideal Body Weight (IBW)
Male IBW = 50kg + 2.3kg (each inch over 5 feet)
Female IBW = 45.5kg + 2.3kg (each inch over 5 feet)
Adjusted Body Weight
Adjusted
= IBW + 0.4 (Actual weight – IBW)
