From the Guidelines
Vancomycin dosing should start at 15-20 mg/kg (actual body weight) every 8-12 hours for adults with normal renal function, with a usual initial dose of 1000-1500 mg every 12 hours, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- Dosing should be adjusted based on therapeutic drug monitoring, aiming for trough concentrations of 10-15 mg/L for most infections or 15-20 mg/L for severe infections like endocarditis, osteomyelitis, meningitis, or MRSA pneumonia 1.
- For critically ill patients, a loading dose of 25-30 mg/kg may be appropriate 1.
- Renal function must be monitored closely, with dose adjustments needed for patients with impaired kidney function 1.
- Continuous infusion regimens (targeting 20-25 mg/L steady-state concentration) may be used in some settings, but are not recommended as a primary approach 1.
- Vancomycin is primarily eliminated by glomerular filtration, so creatinine clearance significantly impacts dosing requirements 1.
- Regular monitoring of trough levels, typically before the fourth dose, helps ensure therapeutic efficacy while minimizing nephrotoxicity risk 1.
Special Populations
- Pediatric dosing differs, generally requiring 10-15 mg/kg every 6 hours, while neonatal dosing varies by age and weight 1.
- For patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution, trough monitoring is recommended to achieve target concentrations of 15-20 lg/mL 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Infusion-related events are related to both the concentration and the rate of administration of vancomycin. Concentrations of no more than 5 mg/mL and rates of no more than 10 mg/min, are recommended in 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. In neonates, an initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours for neonates in the 1st week of life and every 8 hours thereafter up to the age of 1 month. DOSAGE TABLE FOR VANCOMYCIN IN PATIENTS WITH IMPAIRED RENAL FUNCTION
The vancomycin dose is as follows:
- Adults with normal renal function: 2 g daily, divided as 500 mg every 6 hours or 1 g every 12 hours
- Pediatric patients: 10 mg/kg every 6 hours
- Neonates: initial dose of 15 mg/kg, followed by 10 mg/kg every 12 hours for the first week of life and every 8 hours thereafter
- Patients with impaired renal function: dosage adjustment required, with initial dose no less than 15 mg/kg and maintenance dose based on creatinine clearance 2
From the Research
Vancomycin Dosing Guidelines
- The current vancomycin therapeutic guidelines recommend empiric doses of 15-20 mg/kg administered by intermittent infusion every 8-12 h in patients with normal kidney function 3.
- The guidelines also recommend a trough concentration of 15-20 mg/L as a therapeutic goal for adult patients with severe infections 3.
Factors Affecting Vancomycin Dosing
- Creatinine clearance is an important factor in vancomycin dosing, with higher doses required for patients with higher creatinine clearance 4.
- Body mass index (BMI) also affects vancomycin dosing, with lean patients requiring higher doses and obese patients requiring lower doses 5.
- Renal function impairment can affect vancomycin dosing, with patients with renal impairment requiring more careful monitoring and potentially lower doses 6, 7.
Comparison with Other Antibiotics
- Vancomycin has been compared to linezolid in patients with hospital-acquired pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA), with linezolid showing better clinical outcomes in patients with renal impairment 6.
- Vancomycin has also been compared to linezolid in critically ill patients with impaired renal function, with linezolid showing less nephrotoxicity and better renal function improvement 7.