What is the vancomycin infusion rate to achieve a target serum concentration of 20mg/L in a 60kg patient?

From the Guidelines

Vancomycin infusion rate to achieve a target serum concentration of 20mg/L in a 60kg patient is 15-20 mg/kg given every 8-12 hours.

Key Points

• The recommended vancomycin dosage is 15-20 mg/kg given every 8-12 hours for patients with normal renal function to achieve trough serum concentrations of 15-20 mg/L 1.
• For a 60kg patient, the dosage would be 900-1200 mg every 8-12 hours.
• When individual doses exceed 1 g, the infusion period should be extended to 1.5-2 h 1.
• A loading dose of 25-30 mg/kg is suggested to rapidly achieve the target trough drug concentration in critically ill patients 1.
• Therapeutic drug monitoring is recommended to ensure target serum concentrations are achieved and to minimize toxicity 1.
• The target residual concentration or steady-state concentration for vancomycin is around 20 mg/L, which can be higher for specific infected sites 1.
• Continuous infusion of vancomycin after a loading dose can help achieve target plasma concentrations more rapidly and limit the number of blood assays 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 vancomycin infusion rate to achieve a target serum concentration is not directly provided in the label. However, the label recommends an infusion rate of no more than 10 mg/min.

• To determine the infusion rate for a 60kg patient, we need to calculate the dose first.
• The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours.
• For a target serum concentration of 20mg/L, the dose and infusion rate cannot be directly calculated from the provided information. However, the label does provide a recommended infusion rate of no more than 10 mg/min. The dose required to achieve the target serum concentration of 20mg/L in a 60kg patient cannot be determined from the label. Therefore, a conservative approach would be to follow the recommended infusion rate of no more than 10 mg/min and monitor serum concentrations closely 2.

From the Research

Vancomycin Infusion Rate

To achieve a target serum concentration of 20mg/L in a 60kg patient, the following information can be considered:

• A study by 3 found that a 35-mg/kg loading dose was necessary to rapidly achieve vancomycin concentrations of 20 mg/liter.
• The same study found that daily vancomycin requirements were dependent on creatinine clearance, such that a patient with a creatinine clearance of 100 ml/min/1.73 m² would require at least 35 mg/kg per day by continuous infusion to maintain target concentrations.
• Another study by 4 used a dosing algorithm for continuous vancomycin administration, which included a loading dose of 20 mg per kg actual body weight, followed by a continuous infusion of 20 or 30 mg of vancomycin per kg actual body weight over 24 hours, depending on renal function.
• The vancomycin infusion rate was adjusted to achieve a target serum vancomycin concentration of 20-30 mg/L in the study by 4.

Key Points

• The required loading dose and daily infusion rate may vary depending on the patient's renal function and other factors.
• The studies suggest that a higher loading dose and daily infusion rate may be necessary to achieve and maintain therapeutic vancomycin concentrations in critically ill patients.
• The following vancomycin infusion rates can be considered:
  • 35 mg/kg per day by continuous infusion, as suggested by 3
  • 20-30 mg/kg per day by continuous infusion, as used in the study by 4
• It is essential to monitor serum vancomycin concentrations and adjust the infusion rate accordingly to ensure therapeutic levels are achieved and maintained.