Is 1g vancomycin (Vancomycin Hydrochloride) in 200 mL of saline a recommended preparation for infusion?

Vancomycin 1g in 200 mL Saline: Recommended Preparation

Yes, 1g vancomycin in 200 mL of saline is the minimum recommended dilution volume and is appropriate for infusion. This preparation meets FDA-approved dilution requirements and aligns with safety guidelines to prevent infusion-related reactions.

FDA-Approved Dilution Requirements

• For 1g doses, the FDA label explicitly states that at least 200 mL of solution must be used 1
• The reconstituted vancomycin (1 gram/20 mL) must be further diluted before administration 1
• This dilution should be administered by intermittent IV infusion over a period of at least 60 minutes 1

Infusion Rate and Safety Considerations

• Vancomycin must be infused over at least 60 minutes (for 1g dose) to reduce the risk of histamine-release "red man" syndrome 2
• The 2019 IDSA OPAT guidelines specify infusion times of 60-120 minutes depending on dose 2
• Infusion times less than 60 minutes significantly increase the risk of red man syndrome, which occurred in 9 of 11 volunteers receiving 1g doses in pharmacokinetic studies 3

Concentration Considerations

• The final concentration with 1g in 200 mL equals 5 mg/mL, which is the recommended maximum concentration 1
• The FDA recommends diluting vancomycin solutions to 5 mg/mL or less to minimize the likelihood of precipitation 1
• Higher concentrations increase the risk of physical instability and precipitation, particularly when mixed with other compounds 1

Compatible Diluents

The following diluents are physically and chemically compatible with vancomycin 1:

• 0.9% Sodium Chloride Injection (normal saline)
• 5% Dextrose Injection
• 5% Dextrose and 0.9% Sodium Chloride Injection
• Lactated Ringer's Injection

Stability After Dilution

• Solutions diluted with 5% Dextrose or 0.9% Sodium Chloride may be stored in a refrigerator for 14 days without significant loss of potency 1
• Compounded admixtures should be administered as soon after preparation as feasible 1

Common Pitfalls to Avoid

• Never infuse 1g vancomycin in less than 200 mL of fluid - this violates FDA recommendations and increases adverse reaction risk 1
• Never infuse faster than 60 minutes for a 1g dose - rapid infusion dramatically increases red man syndrome incidence 2, 3
• Avoid mixing vancomycin with β-lactam antibiotics in the same line, as they are physically incompatible and precipitation increases with higher vancomycin concentrations 1, 4
• Adequately flush IV lines between administration of incompatible antibiotics 1