From the FDA Drug Label
DOSAGE TABLE FOR VANCOMYCIN IN PATIENTS WITH IMPAIRED RENAL FUNCTION (Adapted from Moellering et al. 1) Creatinine ClearancemL/minVancomycin Dosemg/24 h ... 30465 20310 10155
To determine the Vancomycin dose for a patient with an eGFR of 30, we can use the provided dosage table.
- The eGFR of 30 falls between the 20-30 mL/min range, but since the exact value for 30 mL/min is not provided, we will use the value for the closest range which is 10155 mg/24h for 10 mL/min and 20310 mg/24h for 20 mL/min.
- Since the eGFR is 30, we can estimate the dose to be between these two values.
- A conservative estimate would be to use the lower value of 10155 mg/24h for 10 mL/min, but considering the eGFR is closer to 20-30 mL/min, a more appropriate dose would be around 1500-2000 mg/24h.
- However, the exact dose cannot be determined without interpolation, and the provided table does not account for values between the specified ranges.
- Therefore, the most accurate answer would be to consult the table and consider a dose around 1500-2000 mg/24h, but this is an estimate and not a direct answer from the table.
- It's also important to note that the initial dose should be no less than 15 mg/kg, even in patients with mild to moderate renal insufficiency.
- The patient's weight and other factors should be considered when determining the final dose. 1
From the Research
Vancomycin Dosing for Impaired Renal Function
The vancomycin dose for a patient with impaired renal function, specifically an estimated glomerular filtration rate (eGFR) of 30, can be determined based on several studies.
- A study from 2021 2 investigated the safety and efficiency of vancomycin in patients with moderate and severe renal dysfunction, suggesting that it may be necessary to increase the dose for patients with severe renal dysfunction while implementing a vancomycin loading dose and monitoring trough concentrations and adverse effects.
- Another study from 1981 3 provided a nomogram for vancomycin dosage adjustment based on renal function, which can be used to estimate the required dose.
- However, the exact dose for a patient with an eGFR of 30 is not explicitly stated in the provided studies.
- A study from 2014 4 found that the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was the best predictor of vancomycin clearances for calculation of a therapeutic vancomycin regimen.
- The study from 2024 5 evaluated the dosing regimen of 45 mg/kg/day after a 20 mg/kg loading dose for patients with eGFR ≥ 50 mL/min, but did not provide specific guidance for patients with eGFR of 30.
Key Considerations
- Vancomycin clearance is highly correlated with renal function, as shown in a study from 1981 3.
- The CKD-EPI equation is a reliable method for estimating vancomycin clearance, as found in a study from 2014 4.
- Therapeutic drug monitoring is essential to adjust vancomycin dosage, especially in patients with impaired renal function, as highlighted in a case report from 2021 6.