From the Guidelines
For an 84 kg patient with normal renal function, the recommended vancomycin dose is 15-20 mg/kg actual body weight every 8-12 hours, which translates to approximately 1,260-1,680 mg per dose, with a typical regimen being 1,500 mg IV every 12 hours, as supported by the most recent and highest quality study 1. The dosing strategy is based on achieving target trough serum concentrations, with trough levels of 15-20 mcg/mL recommended for serious infections like bacteremia, endocarditis, osteomyelitis, meningitis, or pneumonia 1. Some key points to consider when administering vancomycin include:
- Therapeutic drug monitoring is essential, with trough levels measured just before the fourth dose (assuming stable renal function) 1.
- Infusion-related reactions can occur, so administering over at least 60 minutes (or longer for doses exceeding 1 gram) is advised to minimize "red man syndrome" 1.
- Renal function should be monitored regularly during therapy as vancomycin can cause nephrotoxicity, and dose adjustments will be necessary if the patient's renal function changes during treatment 1. It's also important to note that vancomycin dosages should be adjusted based on actual body weight, particularly in obese patients, who may be underdosed with conventional dosing strategies 1. Overall, the goal of vancomycin therapy is to achieve optimal trough concentrations while minimizing the risk of toxicity, and regular monitoring and dose adjustments are crucial to ensuring effective and safe treatment 1.
From the FDA Drug Label
Patients with Normal Renal Function Adults The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours.
- For an 84 kg patient with normal renal function, the recommended vancomycin dose is not directly based on weight, but rather a standard dose.
- The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours.
- This dose should be administered at no more than 10 mg/min or over a period of at least 60 minutes, whichever is longer 2.
From the Research
Vancomycin Dosing for an 84 kg Patient with Normal Renal Function
The recommended vancomycin dose for a patient with normal renal function is typically based on the patient's weight.
- The current vancomycin therapeutic guidelines recommend empiric doses of 15-20 mg/kg administered by intermittent infusion every 8-12 hours in patients with normal kidney function 3.
- For an 84 kg patient, the dose would be calculated as follows:
- 15 mg/kg: 84 kg x 15 mg/kg = 1260 mg
- 20 mg/kg: 84 kg x 20 mg/kg = 1680 mg
- Therefore, the recommended dose for an 84 kg patient with normal renal function would be 1260-1680 mg every 8-12 hours.
Considerations for Vancomycin Dosing
It's essential to note that vancomycin dosing may need to be adjusted based on individual patient factors, such as renal function and body mass index (BMI).
- A study found that vancomycin doses that enabled the achievement of AUC400 in elderly patients with normal renal function decreased with increasing BMI 4.
- Another study suggested that a loading dose of 25-30 mg/kg may be associated with increased early clinical response, but did not achieve the optimal trough concentration at steady state in patients with normal renal function 5.