What is the recommended dosage and treatment duration of vancomycin (generic name) for a 10-11kg child with suspected infection?

Vancomycin Dosing for a 10-11kg Child

For a 10-11kg child with suspected infection, administer vancomycin 15 mg/kg IV every 6 hours (total 60 mg/kg/day), infused over at least 60 minutes per dose, targeting trough concentrations of 10-15 μg/mL for moderate infections or 15-20 μg/mL for severe infections such as bacteremia, meningitis, or osteomyelitis. 1, 2

Weight-Based Dosing Calculation

For a 10-11kg child:

• Standard dose: 15 mg/kg × 10.5 kg (midpoint) = 157.5 mg per dose (round to 150-160 mg) 1
• Frequency: Every 6 hours (4 doses daily) 1, 2
• Total daily dose: 60 mg/kg/day = 630 mg/day for 10.5 kg child 1

Infusion Guidelines

• Infusion duration: Minimum 60 minutes per dose 1, 2
• Maximum concentration: 5 mg/mL (10 mg/mL only in fluid-restricted patients with increased infusion-related event risk) 2
• Maximum infusion rate: 10 mg/min 2
• For a 150 mg dose: dilute in 30 mL minimum (5 mg/mL concentration) and infuse over 60 minutes 2

Therapeutic Drug Monitoring

Obtain trough levels before the 4th or 5th dose at steady state to guide dosing adjustments: 1

• Moderate infections (uncomplicated bacteremia, skin/soft tissue): Target trough 10-15 μg/mL 1
• Severe infections (meningitis, osteomyelitis, pneumonia, complicated bacteremia): Target trough 15-20 μg/mL 1
• Target AUC/MIC ratio: >400 1

The FDA label confirms that pediatric patients typically receive 10 mg/kg per dose every 6 hours with close monitoring of serum concentrations, though this represents older guidance that may underdose children. 2 More recent evidence supports the 15 mg/kg every 6 hours regimen to achieve adequate AUC/MIC ratios. 1, 3

Duration by Infection Type

Based on MRSA treatment guidelines: 4

• Uncomplicated bacteremia: 2 weeks 4
• Complicated bacteremia: 4-6 weeks 4
• Pneumonia: 7-21 days 4
• Meningitis: 14 days 4
• Osteomyelitis: >6 weeks 4
• Septic arthritis: 3-4 weeks 4

Dosing Adjustments for Special Populations

For augmented renal clearance (common in critically ill children), higher doses may be required: 5

• Children 1 month to 12 years with ARC may need 75 mg/kg/day (18.75 mg/kg every 6 hours) 5
• Standard 60 mg/kg/day dosing is associated with high risk of underdosing in ARC 5

For neonates <1 month (if applicable to younger end of weight range): 2

• Initial dose: 15 mg/kg 2
• Maintenance: 10 mg/kg every 12 hours (first week of life) or every 8 hours (thereafter up to 1 month) 2

Critical Pitfalls to Avoid

• Never use fixed 1 g doses without weight-based calculation—this results in underdosing in pediatric patients 1
• Do not target high trough levels (15-20 μg/mL) for non-severe infections, as this unnecessarily increases nephrotoxicity risk 1
• Mandatory TDM is required for serious infections, renal dysfunction, obesity, and fluctuating volumes of distribution 1
• Consider alternative therapy if organism MIC ≥2 μg/mL, as target AUC/MIC ratios are not achievable with vancomycin 1

Loading Dose Consideration

For critically ill children with suspected MRSA sepsis, meningitis, or necrotizing infections: 1

• Loading dose: 25-30 mg/kg (actual body weight) 1
• Infuse over 2 hours (prolonged from standard 60 minutes) 1
• Consider premedication with antihistamine to reduce red man syndrome risk 1

Transition to Oral Therapy

Once clinically stable and susceptibility results available, clindamycin 10-13 mg/kg/dose every 6-8 hours (maximum 40 mg/kg/day) can be considered for step-down therapy if organism is susceptible. 4, 6 This applies primarily to skin/soft tissue infections and uncomplicated bacteremia without endovascular involvement. 4