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Round all doses to nearest 250mg
Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q12H
Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q18H
Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose Q24H
Vancomycin 20 mg/kg loading dose then 15 mg/kg maintenance dose
Contact clinical pharmacist for assistance
Patients should receive a loading dose followed by 3 hour and 24
hour post-dose serum levels to determine subsequent dosing
These patients have unstable and/or reduced renal function and the nomogram may not be as predictive
In elderly patients (age > 60) with low muscle mass, use clinical judgement as SCr may not reflect renal function accurately
