Spectrum: Local Antimicrobial Stewardship, for Fraser Health

Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Adult

Loading dose: 25mg/kg IV once

Maintenance dose: 15mg/kg IV q8-12h depending on trough goal

Rounded to nearest 250 mg (suggested maximum of 2500 mg/dose)

Renal

Nomogram

General Information

Drug Monitoring

Drug Monitoring

Collect trough 0-1h before 3rd or 4th dose.

Target trough 15-20 mg/L for most serious infections, 10-15 mg/L for skin/soft tissue infections or UTI.

If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval

If trough >20, increase dosing interval or decrease dose

Monitor creatinine at least once weekly

Adverse Effects

Adverse Effects

Red man syndrome (histamine release- slow down infusion), nephrotoxicity, cytopenias, rash including Stevens-Johnson Syndrome

Major Interactions

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Careful with concomitant nephrotoxins

Pharmacology

Pharmacology

Antimicrobial class: Glycopeptide

Pregnancy category: C