What is the recommended dosage and duration of vancomycin for a patient with a wound infection due to Staphylococcus (Staph) aureus, with normal renal function (Glomerular Filtration Rate (GFR) > 60), and sensitive to vancomycin, weighing 62.7 kilograms?

Vancomycin Dosing for Wound Infection with Staphylococcus aureus

For a 62.7 kg patient with normal renal function (GFR >60) and a vancomycin-sensitive Staphylococcus aureus wound infection, administer vancomycin 15-20 mg/kg IV every 8-12 hours for 7-14 days, which translates to approximately 940-1254 mg per dose (round to 1000-1250 mg per dose in practice). 1

Specific Dosing Calculation

Weight-based dosing is critical and mandatory:

• At 15 mg/kg: 62.7 kg × 15 mg/kg = 940 mg per dose 2, 3
• At 20 mg/kg: 62.7 kg × 20 mg/kg = 1254 mg per dose 2, 3
• Practical dosing: 1000 mg IV every 12 hours is appropriate for this patient weight with a non-severe wound infection 1, 3
• Fixed 1 g doses every 12 hours are adequate for patients with normal renal function who are not obese and have non-severe skin and soft tissue infections 1, 3

Duration of Therapy

Treat for 7-14 days based on clinical response:

• The Infectious Diseases Society of America recommends 7-14 days for complicated skin and soft tissue infections, including surgical/traumatic wound infections 1
• Duration should be individualized based on wound healing, resolution of systemic signs, and clinical improvement 1

Dosing Interval Selection

For this patient with normal renal function:

• Every 12 hours is the standard interval for non-severe infections 1
• Every 8 hours may be considered if the infection is severe or if initial trough levels are subtherapeutic 4

Therapeutic Monitoring Requirements

Trough monitoring is NOT required for this patient:

• For most patients with skin and soft tissue infections who have normal renal function and are not obese, traditional doses of 1 g every 12 hours are adequate and trough monitoring is not required 1, 3
• If monitoring is performed, target trough concentrations of 10-15 μg/mL are sufficient for non-severe infections 3
• For serious infections (bacteremia, endocarditis, osteomyelitis, necrotizing fasciitis), target trough concentrations of 15-20 μg/mL would be required 1, 2

Loading Dose Consideration

A loading dose is NOT necessary for this patient:

• Loading doses of 25-30 mg/kg are reserved for seriously ill patients with sepsis, meningitis, pneumonia, endocarditis, or necrotizing fasciitis 1, 2, 3
• A simple wound infection does not meet criteria for loading dose administration 2

Common Pitfalls to Avoid

Critical dosing errors to prevent:

• Never use fixed 1 g doses without considering patient weight in severe infections—this results in underdosing in patients >70 kg 2, 5
• However, for this 62.7 kg patient with a non-severe wound infection, 1 g every 12 hours is appropriate 3
• Do not target high trough levels (15-20 μg/mL) for non-severe wound infections, as this unnecessarily increases nephrotoxicity risk 2, 3
• Ensure adequate surgical debridement and drainage if the wound has purulent material or abscess formation, as antibiotics alone are insufficient 1

Alternative Agents if Needed

If vancomycin cannot be used:

• Oral options for outpatient management include clindamycin, trimethoprim-sulfamethoxazole, doxycycline, or linezolid 1
• For hospitalized patients, alternatives include linezolid 600 mg IV/PO twice daily, daptomycin 4 mg/kg IV once daily, or clindamycin 600 mg IV/PO three times daily 1