Vancomycin Dosing for Soft Tissue Infections with Normal Renal Function
For uncomplicated cellulitis in adults with normal renal function, administer vancomycin 1 g IV every 12 hours without routine trough monitoring. 1
Severity-Based Dosing Algorithm
Uncomplicated Cellulitis (Non-Severe Soft Tissue Infections)
- Standard fixed dosing of 1 g IV every 12 hours is adequate for most non-obese patients with normal renal function. 1
- Trough monitoring is not required for this population. 1, 2
- Each dose should be infused over at least 60 minutes at a rate no faster than 10 mg/min to minimize infusion-related reactions. 3
Severe or Complicated Soft Tissue Infections
- Use weight-based dosing of 15-20 mg/kg (actual body weight) every 8-12 hours. 1, 2
- Target trough concentrations of 15-20 mg/L are required for severe infections. 1, 2
- Consider a loading dose of 25-30 mg/kg (actual body weight) for seriously ill patients to rapidly achieve therapeutic concentrations. 2
- Obtain trough levels before the fourth or fifth dose to ensure therapeutic targets are met. 2
Critical Dosing Considerations by Body Habitus
Obese Patients
- Conventional 1 g every 12 hours dosing leads to subtherapeutic levels in obese patients. 1
- Weight-based dosing using actual body weight is mandatory in this population. 1, 2
- Trough monitoring is required for obese patients even with uncomplicated infections. 1
Normal Weight, Non-Obese Patients
- Traditional 1 g every 12 hours dosing is sufficient for uncomplicated infections. 1, 2
- For patients weighing >70 kg with severe infections, calculate doses based on 15-20 mg/kg rather than using fixed 1 g doses. 2
Infusion Guidelines to Prevent Adverse Events
- Infuse each dose over at least 60 minutes, or longer if the dose exceeds 1 g. 3
- For doses >1 g, extend infusion time to 1.5-2 hours to minimize infusion-related adverse effects. 1
- Maximum infusion rate should not exceed 10 mg/min. 3
- Maximum concentration should be 5 mg/mL (up to 10 mg/mL only in fluid-restricted patients, though this increases infusion-related event risk). 3
Common Pitfalls to Avoid
- Do not use fixed 1 g every 12 hours dosing in obese patients without weight-based calculation—this consistently results in underdosing. 1
- Do not target high trough levels (15-20 mg/L) for uncomplicated cellulitis, as this unnecessarily increases nephrotoxicity risk without improving outcomes. 2
- Avoid continuous infusion vancomycin, as it offers no clear benefit over intermittent dosing. 1
- Do not administer vancomycin doses ≥4 g/day, as this is associated with significantly increased nephrotoxicity (34.6% vs 10.9% with standard dosing). 4
When Therapeutic Monitoring Is Required
- Monitoring is mandatory for severe infections requiring trough targets of 15-20 mg/L. 1, 2
- Monitor in obese patients regardless of infection severity. 1
- Monitor in patients receiving prolonged therapy or those at risk for toxicity. 1
- For uncomplicated cellulitis in non-obese patients with normal renal function, routine trough monitoring is not necessary. 1, 2