Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Vancomycin IV

C. diff Risk

Low

Oral Bioavailability

None

Approximate Cost

$15 + monitoring

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Renal

Pharmacy doses all inpatient vancomycin.

Adjust vancomycin for goal AUC 400-600

Call pharmacy for dosing questions

Pediatric

1 year old or olderOrder pharmacist to dose vancomycin
60-80 mg/kg/day divided q6-8 hours

Adult

Order Pharmacist to Dose Vancomycin

May consider load in septic shock patients: 25-30mg/kg IV loading dose rounded to nearest 250mg (max of 2g per dose).

15mg/kg IV q8-12h maintenance depending on trough goal.

General Information

Unacceptable Uses

Unacceptable Uses

MSSA infections - beta lactams have better outcome data and are preferred for the treatment of MSSA

Common Usage

Common Usage

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, ampicillin resistant Enterococcal infections.

Drug Monitoring

Drug Monitoring

Requires monitoring:

Goal AUC:400-600
Need 2 random vancomycin levels to calculate AUC. Generally draw peak 1 hour after end of infusion, draw trough 30 min before next dose and pharmacist can calculate AUC.

Changing renal function, dialysis or meningitis:
Target trough 15-20mcg/mL for most serious infections, 20-25mcg/mL for meningitis.

Adverse Effects

Adverse Effects

  •  Nephrotoxicity, especially in presence of other nephrotoxins

  •  Cytopenias

  •  Rash including Stevens-Johnson Syndrome

  •  Red man syndrome (histamine release- slow down infusion)

Major Interactions

Major Interactions

Aminoglycosides, ketorolac and contrast may potentiate nephrotoxicity.

Careful with concomitant nephrotoxins.

Pharmacology

Pharmacology

Antimicrobial class: Glycopeptide

Pregnancy category: C

Average serum half life: 8 hours

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic