What are the doses of Vancomycin (Vanco) and Ceftriaxone for a 65kg male patient with meningitis, including frequency and duration of treatment in the Intensive Care Unit (ICU)?

From the Guidelines

For a 65kg male patient with meningitis, the recommended doses are Vancomycin 15-20 mg/kg every 8-12 hours and Ceftriaxone 2g every 12 hours.

Treatment Details

• The dose of Vancomycin is based on actual body weight, with a target trough serum concentration of 15-20 mg/mL 1.
• The dose of Ceftriaxone is 2g every 12 hours, with no weight-based adjustment needed for this patient 1.

Frequency and Duration of Treatment

• Vancomycin should be administered every 8-12 hours, with trough serum concentrations monitored to ensure target levels are achieved 1.
• Ceftriaxone should be administered every 12 hours, with treatment duration depending on the specific pathogen and clinical response 1.
• Treatment duration for meningitis typically ranges from 10-14 days, but may be extended to 21 days in certain cases, such as Listeria monocytogenes infection or if the patient has not fully recovered 1.

Important Considerations

• It is essential to monitor renal function and adjust Vancomycin doses accordingly, as nephrotoxicity is a potential side effect 1.
• The use of adjunctive therapies, such as dexamethasone, should be considered on a case-by-case basis, taking into account the specific pathogen and clinical scenario 1.

From the FDA Drug Label

For the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams). Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended. The usual duration of therapy is 7 to 14 days The dosages recommended for adults require no modification in elderly patients, up to 2 grams per day, provided there is no severe renal and hepatic impairment At the time of use, reconstitute the vials of Vancomycin Hydrochloride for Injection, USP with Sterile Water for Injection to a concentration of 50 mg of vancomycin/mL The desired dose diluted in this manner should be administered by intermittent IV infusion over a period of at least 60 minutes.

For a 65kg male patient with meningitis:

• Ceftriaxone: The initial dose is 100 mg/kg (not to exceed 4 grams), which is 6.5 grams. However, since the dose cannot exceed 4 grams, the initial dose is 4 grams. The total daily dose is also 100 mg/kg/day, which is 6.5 grams. Again, since the dose cannot exceed 4 grams, the total daily dose is 4 grams. The usual duration of therapy is 7 to 14 days.
• Vancomycin: The dose is not explicitly stated for meningitis in the provided drug label. However, for IV administration, the solution should be diluted to 5 mg/mL or less and administered by intermittent IV infusion over a period of at least 60 minutes.

Note: The provided drug label for Vancomycin does not include a recommended dose for meningitis. Therefore, the dose for Vancomycin cannot be determined based on the provided information 2 3.

From the Research

Vancomycin Dosing

• The dosing of vancomycin in adult ICU patients is influenced by factors such as age, renal function, and serum creatinine levels 4.
• A study found that the conventional dosing regimen of vancomycin may be suboptimal in adult ICU patients, and simulations can provide useful information for initial assessment of vancomycin dosing 4.
• For a 65kg male patient, the vancomycin dose may need to be adjusted based on renal function and other factors, but the exact dose is not specified in the provided studies.
• A study on critically ill trauma patients found that the median vancomycin loading dose was 24.6 mg/kg, with an initial maintenance dose of 17.71 mg/kg, and dosing intervals of every 8 or 12 hours 5.

Ceftriaxone Dosing

• High-dose ceftriaxone is used to treat central nervous system (CNS) infections, including meningitis, and the dosage should be adapted to the patient's glomerular filtration rate and total body weight 6.
• A study found that a dosing nomogram can be used to determine the optimal dosage of ceftriaxone for patients with suspected bacterial meningitis, with a target plasma trough concentration of ≥20 mg/L 6.
• For a 65kg male patient with meningitis, the ceftriaxone dose may be in the range of 75-100 mg/kg/day, without an upper limit, as recommended by French guidelines 6.
• An older study found that ceftriaxone was effective in treating meningitis and other severe bacterial infections in pediatric and young adult patients, with dosages ranging from 25-50 mg/kg every 12 hours 7.

Treatment Duration and Frequency

• The duration and frequency of vancomycin and ceftriaxone treatment in the ICU setting are not explicitly stated in the provided studies, but are likely to be individualized based on patient response and clinical factors.
• A study on vancomycin dosing in critically ill patients found that therapeutic drug monitoring can help optimize vancomycin concentrations, but the optimal duration of treatment was not specified 8.
• Another study found that ceftriaxone therapy was effective in treating meningitis and other infections, with treatment durations not explicitly stated, but likely to be based on clinical response and microbiological clearance 7.