What is the recommended dose of vancomycin (Vancomycin hydrochloride) for adults?

From the Guidelines

The recommended dose of vancomycin for adults is typically 15-20 mg/kg (based on actual body weight) administered intravenously every 8-12 hours, with a usual daily dose of 2-3 grams divided into 2-4 doses, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• Dosing should be adjusted based on renal function, as vancomycin is primarily eliminated by the kidneys.
• For patients with normal renal function, a common regimen is 1 gram IV every 12 hours.
• Therapeutic drug monitoring is essential, with target trough concentrations of 10-15 μg/mL for most infections and 15-20 μg/mL for severe infections like endocarditis, osteomyelitis, meningitis, or pneumonia caused by MRSA 1.
• The medication should be administered as a slow infusion over at least 60 minutes (or longer for higher doses) to prevent "red man syndrome," a histamine-related reaction characterized by flushing, rash, and hypotension.
• Loading doses of 25-30 mg/kg may be considered in critically ill patients to achieve therapeutic levels more quickly.

Special Populations

• Obese patients may require higher doses based on their actual body weight, as they are likely to be underdosed with conventional dosing strategies 1.
• Patients with renal dysfunction or fluctuating volumes of distribution may require more frequent monitoring of vancomycin trough concentrations 1.

Evidence Summary

The recommended dose of vancomycin is based on the guidelines from the Infectious Diseases Society of America, which suggest that vancomycin doses of 15-20 mg/kg/day every 8-12 hours 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 1. Similar recommendations are made by other studies, including those published in 2011 1 and 2009 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... 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.

• The recommended dose of vancomycin for adults with normal renal function is 2 g per day, which can be administered as:
  • 500 mg every 6 hours
  • 1 g every 12 hours 2

From the Research

Vancomycin Dosing for Adults

The recommended dose of vancomycin for adults varies based on several factors, including the patient's weight, renal function, and the severity of the infection.

• 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.
• A study published in 2020 recommends a dose of 35 mg/kg/day (maximum 5500 mg/day) for obese individuals without renal impairment, with corresponding trough concentrations of 5.7-14.6 mg/L (twice daily dosing) 4.
• Another study published in 2009 suggests that a vancomycin regimen of 1 g i.v. every 12 hours in critically ill trauma patients with MRSA pneumonia and normal renal function is unlikely to achieve trough concentrations of 15 to 20 mg/L, and doses of at least 1 g i.v. every 8 hours are needed 5.
• An older study published in 1977 recommends a dose of 1 g every 12 hours in patients who have normal renal function 6.

Special Considerations

• Obesity is an established risk factor for vancomycin-induced nephrotoxicity, and dosing calculations and volume of distribution estimation should be taken into account when administering vancomycin to obese patients 7.
• The use of area under the curve (AUC) monitoring instead of trough-only monitoring may be beneficial in reducing the risk of nephrotoxicity and improving the efficacy of vancomycin therapy 7, 3.
• Continuous infusion of vancomycin may also be considered as an alternative to intermittent infusion, as it may provide more consistent and predictable drug concentrations 3.