From the Guidelines
For coagulase-negative Staphylococcus urinary tract infections, vancomycin should be dosed at 15-20 mg/kg actual body weight every 8-12 hours, not to exceed 2 g per dose, as recommended by the Infectious Diseases Society of America 1. The recommended dosing is based on the patient's actual body weight and should be adjusted for the patient's estimated creatinine clearance. Key considerations for vancomycin dosing include:
- Weight-based dosing is particularly important in obese patients to avoid underdosing 1
- Vancomycin trough concentrations of 15-20 lg/mL are recommended for serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe skin and soft tissue infections (SSTI) due to MRSA 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
- The duration of treatment is usually 7-14 days depending on infection severity, and therapeutic drug monitoring is recommended to maintain trough levels between 10-20 mcg/mL 1
- Before starting vancomycin, obtain cultures and susceptibility testing to confirm the organism is not methicillin-sensitive, as alternative antibiotics would be preferred in that case
- Monitor renal function during therapy as vancomycin can cause nephrotoxicity, and adequate hydration should be maintained throughout treatment 1