From the Guidelines
For MRSA wound infections, the recommended vancomycin dosing regimen with normal creatinine is typically 15-20 mg/kg actual body weight every 8-12 hours, with a target trough level of 15-20 μg/mL for serious infections, as recommended by the Infectious Diseases Society of America 1. This higher trough range ensures adequate tissue penetration and optimal killing of MRSA. For less severe infections, a trough of 10-15 μg/mL may be sufficient. Initial dosing should be calculated based on actual body weight, with trough levels measured before the fourth dose (at steady state) when using q12h dosing. Some key points to consider when administering vancomycin include:
- Dose adjustments should be made based on trough levels - if the trough is too low, increase the dose or frequency; if too high, decrease accordingly, as suggested by 1 and 1.
- Monitoring renal function is essential during therapy as vancomycin can cause nephrotoxicity.
- Adequate hydration should be maintained throughout treatment.
- The duration of therapy typically ranges from 7-14 days depending on infection severity, clinical response, and wound healing progress.
- Vancomycin should be administered as a slow infusion (over at least 60-120 minutes) to prevent "red man syndrome," a histamine-related reaction characterized by flushing and hypotension. It is also important to note that vancomycin doses of 15–20 mg/kg/day every 8–12 h are recommended for adult patients on the basis of actual body weight and are adjusted for the patient’s estimated creatinine clearance, not to exceed 2 g per dose, as stated in 1 and 1.
From the Research
Vancomycin Dosing for MRSA Wound Infections
- For patients with normal creatinine levels, the vancomycin dose can be determined based on the patient's creatinine clearance (CLcr) 2
- The recommended vancomycin doses for patients with various degrees of renal function impairment are:
- 20 mg/kg every 12 h for CLcr of 80-100 ml/min
- 18 mg/kg every 12 h for CLcr of 70 ml/min
- 25 mg/kg every 24 h for CLcr of 50-60 ml/min
- 22 mg/kg every 36 h for CLcr of 40 ml/min
- 18 mg/kg every 48 h for CLcr of 30 ml/min
- The goal is to maintain a peak vancomycin level of 25-40 microg/ml and a trough level under 15 microg/ml 2
- Other studies have compared the effectiveness and safety of vancomycin with other antibiotics, such as linezolid, teicoplanin, and daptomycin, for the treatment of MRSA infections 3, 4, 5, 6
Trough Levels and Dosing Intervals
- The trough level of vancomycin should be kept under 15 microg/ml to minimize the risk of toxicity 2
- The dosing interval for vancomycin can be adjusted based on the patient's renal function and the desired trough level 2
- Computer simulations have confirmed the usefulness of these recommendations for vancomycin dosing in patients with MRSA pneumonia 2