What is the intravenous (IV) vancomycin dosing in milligrams per kilogram (mg/kg) for a diabetic foot infection in a non-septic patient with normal renal function?

From the Guidelines

For diabetic foot infections in non-septic patients with normal renal function, the recommended IV vancomycin dosing is 15-20 mg/kg actual body weight every 8-12 hours, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1.

Key Considerations

• The dosing should be based on actual body weight, and adjusted for the patient's estimated creatinine clearance, not to exceed 2 g per dose 1.
• Weight-based dosing is particularly important in obese patients, who are likely to be underdosed when conventional dosing strategies are used 1.
• The pharmacodynamic parameter that best predicts efficacy of vancomycin is the ratio of the area under the curve (AUC) to the MIC (AUC/MIC), with a target AUC/MIC >400 1.
• Vancomycin trough concentrations of 15-20 μg/mL are recommended for serious infections, but for most patients with skin and soft tissue infections (SSTI) who have normal renal function and are not obese, traditional doses may be adequate and trough monitoring is not required 1.

Dosing and Monitoring

• For patients with normal renal function, the recommended dosing is 15-20 mg/kg every 8-12 hours, which can be adjusted based on renal function and trough levels 1.
• Trough vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution 1.
• Continuous infusion vancomycin regimens are not recommended, and loading doses of 25 mg/kg may be considered in certain situations, but are not typically necessary for diabetic foot infections in non-septic patients 1.

From the FDA Drug Label

Patients with Normal Renal Function Adults The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours. Pediatric patients The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every 6 hours.

The intravenous (IV) vancomycin dosing for a diabetic foot infection in a non-septic patient with normal renal function is 10 mg/kg per dose given every 6 hours, as stated for pediatric patients. However, for adults, the dose is usually 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours, which does not provide a direct mg/kg dosage. To determine the appropriate dosage, the patient's weight in kilograms must be considered.

• For pediatric patients, the dosage is 10 mg/kg per dose.
• For adults, the dosage can be calculated based on the patient's weight, but the label does not provide a direct mg/kg recommendation. Given the information provided, for an adult patient, the dosage would depend on their weight, but a general recommendation for adults with normal renal function is not provided in mg/kg. For pediatric patients, the dosage is clear: 10 mg/kg per dose every 6 hours 2.

From the Research

Vancomycin Dosing for Diabetic Foot Infections

• The dosing of vancomycin for diabetic foot infections is crucial for effective treatment while minimizing the risk of nephrotoxicity.
• According to the study by 3, a modified vancomycin dosing protocol for patients with diabetic foot infections caused by methicillin-resistant Staphylococcus aureus (MRSA) involved administering vancomycin 10-15 mg/kg (up to 1 g) every 12 hours for patients with a serum creatinine concentration of 0.4-1.4 mg/dL.
• However, the optimal dosing strategy may vary depending on individual patient factors, such as renal function and concurrent medication use.
• A study by 4 highlighted the importance of individualized vancomycin dosing, as population pharmacokinetic models may not accurately predict vancomycin exposure in patients with diabetic foot infections.
• The study by 5 compared the effectiveness of daptomycin and vancomycin in treating infected diabetic foot ulcers, but did not provide specific guidance on vancomycin dosing.
• Another study by 6 discussed the risk of vancomycin-induced nephrotoxicity, particularly with high doses or prolonged therapy, but did not provide specific dosing recommendations for diabetic foot infections.

Key Considerations

• Vancomycin dosing should be individualized based on patient factors, such as renal function and body weight.
• The goal of vancomycin therapy is to achieve optimal exposure, typically defined as a trough level of 15-20 mg/L or an area under the curve over 24 hours/minimum inhibitory concentration (AUC24/MIC) ≥ 400.
• Monitoring of vancomycin levels and renal function is essential to minimize the risk of nephrotoxicity, as highlighted by the study by 7.
• Further research is needed to determine the optimal vancomycin dosing strategy for patients with diabetic foot infections, particularly in the context of varying renal function and concurrent medication use.