From the Guidelines
For adult sepsis, the recommended intravenous vancomycin dosing is typically 15-20 mg/kg actual body weight every 8-12 hours, with a usual maximum of 2 grams per dose, and an initial loading dose of 25-30 mg/kg (up to 3 grams) is suggested to rapidly achieve the target trough drug concentration. The dosing strategy should be optimized based on accepted pharmacokinetic/pharmacodynamic principles specific to the drug properties in patients with sepsis or septic shock 1. Vancomycin should be administered as an intermittent infusion over at least 60-120 minutes to prevent "red man syndrome," with a maximum infusion rate of 10 mg/minute (or 1 gram over 100 minutes) 1.
Some key points to consider when administering vancomycin for adult sepsis include:
- Dosing should be adjusted based on therapeutic drug monitoring, aiming for a target trough concentration of 15-20 mg/L for serious infections like sepsis 1.
- Renal function must be monitored closely, with dose adjustments for patients with impaired kidney function 1.
- Hydration should be maintained during administration to minimize nephrotoxicity 1.
- The initial loading dose should be 25-30 mg/kg (up to 3 grams) for critically ill patients with sepsis to rapidly achieve the target trough drug concentration 1.
- Continuous infusions may be used in certain clinical scenarios, but are not generally recommended for vancomycin 1.
Overall, the goal of vancomycin dosing in adult sepsis is to achieve adequate serum concentrations relative to the minimum inhibitory concentration of the pathogen, while minimizing toxicity and optimizing clinical outcomes 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Infusion-related events are related to both the concentration and the rate of administration of vancomycin. Concentrations of no more than 5 mg/mL and rates of no more than 10 mg/min, are recommended in adults Each dose should be administered at no more than 10 mg/min or over a period of at least 60 minutes, whichever is longer. The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours.
The recommended dose of IV vancomycin for adult sepsis is 2 g daily, which can be divided into 500 mg every 6 hours or 1 g every 12 hours. The recommended flow rate is no more than 10 mg/min, and each dose should be administered over a period of at least 60 minutes 2.
- Key points:
- Concentration: no more than 5 mg/mL
- Rate: no more than 10 mg/min
- Dose: 2 g daily
- Administration time: at least 60 minutes
From the Research
Vancomycin Dosing for Adult Sepsis
- The recommended dose of vancomycin for adult sepsis is ≥ 2 g every 8 hours for patients with a creatinine clearance of ≥ 80 mL/min/1.73 m² 3.
- A loading dose of 35 mg/kg is necessary to rapidly achieve vancomycin concentrations of 20 mg/liter 4.
- Daily vancomycin requirements are dependent on creatinine clearance (CrCl), with a patient with a CrCl of 100 ml/min/1.73 m² requiring at least 35 mg/kg per day by continuous infusion to maintain target concentrations 4.
Flow Rate of IV Vancomycin
- The flow rate of IV vancomycin is not explicitly stated in the provided studies, but it is recommended to administer vancomycin by continuous infusion to rapidly achieve therapeutic serum concentrations 5, 4.
- A multi-compartment model can be used to predict vancomycin level evolution throughout the treatment of patients with sepsis, and dose adjustment can be performed to reach target concentrations above 20 mg/l 5.
Therapeutic Targets
- The therapeutic targets for vancomycin in adult sepsis are trough concentrations of 15-20 mg/L 6.
- Target concentrations above 20 mg/l can be achieved with an initial dose of 3 grams of vancomycin per day 5.
- Monte Carlo simulations suggest that vancomycin doses ≥ 2 g every 8 hours are required to consistently achieve key therapeutic targets in patients with a creatinine clearance of ≥ 80 mL/min/1.73 m² 3.