Vancomycin

Typical starting dose:  15 mg/kg based on actual body weight   (as long as the patient has normal renal function, and the dose doesn’t exceed 2000 mg)

  • Should always check computer system for patient records indicating whether the patient has received vanco and if so the dosing used at that time as well as the levels associated with that dosing

Monitoring:

  • Draw trough level should be obtained at steady state prior to the administration of the 4th or 5th dose
    • It is necessary to evaluate whether the trough level was drawn correctly (vanco trough levels should be drawn 30 min. prior to the dose & from a peripheral stick–it should not be drawn from the direct line)
      • Drawing the trough level from the direct line could lead to a falsely elevated level)
      • If the level that is drawn is lower than expected, it is necessary to determine whether any doses were missed as well.
  • Trough monitoring is recommended for patients who have:
    • Renal dysfunction
    • Serious infections
    • Morbid obesity
    • Fluctuating volumes of distribution (ex. Heart failure)
    • Liver failure
  • Optimal trough levels
    • 15-20:  serious infections (ex.  bacteremia, infective endocarditis, pneumonia, severe skin/soft tissue infections)
    • 10-15:  non-severe skin/soft tissue infections, pyelonephritis, less-severe bacteremia
    • >~10:  urinary tract infections

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