From the Guidelines
Vancomycin is administered intravenously (IV) in admitted patients, with a recommended dose of 15-20 mg/kg (actual body weight) every 8-12 hours, not to exceed 2 g per dose, for patients with normal renal function. This recommendation is based on the clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in adults and children 1. The IV administration of vancomycin is necessary due to its poor oral bioavailability, which is less than 5% 1.
Key Considerations for Vancomycin Administration
- The standard adult dosing is typically 15-20 mg/kg (actual body weight) every 8-12 hours, with adjustments made based on renal function and therapeutic drug monitoring 1.
- Vancomycin requires careful monitoring of drug levels, with target trough concentrations typically between 10-20 mcg/mL depending on the infection being treated 1.
- Patients receiving IV vancomycin should be monitored for potential adverse effects including nephrotoxicity, ototoxicity, and infusion reactions like "red man syndrome," which can be minimized by extending the infusion time to at least 60 minutes.
Evidence-Based Recommendations
- The Infectious Diseases Society of America recommends IV vancomycin for the treatment of MRSA infections, including meningitis, brain abscess, and septic thrombosis of cavernous or dural venous sinus 1.
- The recommended dose of vancomycin is 15-20 mg/kg (actual body weight) every 8-12 hours, with adjustments made based on renal function and therapeutic drug monitoring 1.
Clinical Implications
- IV vancomycin administration is a critical component of the treatment regimen for serious infections caused by gram-positive bacteria, particularly MRSA.
- Careful monitoring of drug levels and potential adverse effects is necessary to ensure effective and safe treatment with vancomycin.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Infusion-related events are related to both the concentration and the rate of administration of vancomycin. The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours. Each dose should be administered at no more than 10 mg/min or over a period of at least 60 minutes, whichever is longer.
Vancomycin Administration: Vancomycin is administered intravenously (IV) in admitted patients. The dose and administration rate may vary based on patient factors such as age, weight, and renal function. 2
From the Research
Administration of Vancomycin
- Vancomycin is administered intravenously (IV) in admitted patients, as stated in the studies 3, 4, 5, 6, 7.
- The IV administration of vancomycin is a common practice for treating various infections, including staphylococcal infections, in patients with normal renal function or severe renal impairment 3, 4, 5.
Dosage and Nephrotoxicity
- High-dose vancomycin (>20 mg/kg) is not associated with increased nephrotoxicity compared to lower doses (≤20 mg/kg) in patients with severe renal dysfunction or sepsis 3, 5.
- The risk of nephrotoxicity is lower in patients who receive high-dose vancomycin, with a relative risk of 0.53-0.61 3 and 0.60 5.
Special Populations
- Vancomycin can be safely administered to pediatric patients, with effective treatment of staphylococcal infections and minimal side effects 6.
- In haemodialysis patients, a fixed weight-based loading and subsequent dosing guided by pre-dialysis levels can help achieve therapeutic vancomycin levels 7.