What is the recommended dosage for vancomycin (Vancomycin hydrochloride)?

Vancomycin Dosing Recommendations

For adults with normal renal function, vancomycin should be dosed at 15-20 mg/kg every 8-12 hours, typically administered as 2 g daily divided as either 500 mg every 6 hours or 1 g every 12 hours. 1, 2

Standard Dosing Regimens

Adults with Normal Renal Function

• Standard dose: 15-20 mg/kg every 8-12 hours 1
• Typical daily dose: 2 g divided as either 500 mg every 6 hours or 1 g every 12 hours 2
• For serious infections (bacteremia, endocarditis, osteomyelitis, meningitis, pneumonia, severe skin/soft tissue infections): Target trough levels of 15-20 μg/mL 1
• For less severe infections (mild-moderate skin/soft tissue infections): Target trough levels of 10-15 μg/mL 1
• Consider loading dose of 25-30 mg/kg for sepsis and septic shock to rapidly achieve therapeutic levels 1

Pediatric Patients

• Children with serious infections: 15 mg/kg/dose every 6 hours 1
• Standard pediatric dosing: 10 mg/kg every 6 hours 2
• Neonates: Initial dose of 15 mg/kg, followed by 10 mg/kg every 12 hours in first week of life and every 8 hours thereafter up to 1 month of age 2
• Premature infants may require longer dosing intervals due to decreased vancomycin clearance 2

Special Populations

Patients with Renal Impairment

• Daily dose (mg) should be approximately 15 times the glomerular filtration rate in mL/min 1, 2
• For functionally anephric patients: Initial dose of 15 mg/kg, then maintenance dose of 1.9 mg/kg/24 hr 2
• In marked renal impairment: Consider 250-1,000 mg once every several days 2
• In anuria: 1,000 mg every 7-10 days 2

Obese Patients

• Use actual body weight for initial dosage calculation 1
• Morbidly obese patients may require shorter dosing intervals (q8h instead of q12h) to maintain therapeutic trough levels 3

Administration Guidelines

• Maximum concentration: 5 mg/mL (up to 10 mg/mL in patients requiring fluid restriction) 2
• Maximum infusion rate: 10 mg/min 2
• Infusion time: At least 60 minutes per dose (regardless of dose size) to reduce risk of "red man syndrome" 1, 2

Therapeutic Monitoring

• Obtain trough levels immediately before the fourth or fifth dose (at steady state) 1
• Trough concentrations are the most accurate and practical method to guide vancomycin dosing 1
• Pre-dose monitoring of trough concentrations is specifically recommended 1
• Peak concentration monitoring is not recommended 1

Common Pitfalls and Caveats

1. Underdosing in serious infections: Ensure adequate dosing (15-20 mg/kg) for serious infections to achieve target trough levels of 15-20 μg/mL 1, 4

2. Incorrect timing of trough levels: Trough levels should be drawn immediately before the next scheduled dose, not randomly 1

3. Failure to adjust for renal function: Vancomycin clearance correlates with renal function, requiring careful dose adjustment in renal impairment 2, 5

4. Inadequate infusion time: Always infuse over at least 60 minutes regardless of dose to prevent infusion-related reactions 1, 2

5. Inappropriate dosing weight in obese patients: Use actual body weight for initial dosing in obese patients, with careful monitoring of serum levels 1, 3

6. Neglecting loading doses in serious infections: Consider loading doses of 25-30 mg/kg in critically ill patients to rapidly achieve therapeutic levels 1

7. Failure to monitor renal function: Regular monitoring of renal function is essential during vancomycin therapy 1, 2