Vancomycin

See also
o

Antibiotics

Background and Adverse effects

Glycopeptide antibiotic, active against gram positive bacteria. Usually reserved for
treatment of methicillin-resistent staph aureus (MRSA).
Potentially nephrotoxic, ototoxic.
Can cause red man syndrome - flushing or rash on the upper body and neck; muscle
spasm of the neck and back. This is dose and infusion related. Vancomycin should be
infused over a minimum of 60 minutes, and over 120 minutes for doses greater than
500mg, patients with previous reactions, and neonates.

Dose
The dose chosen needs to be guided by the clinical picture and age of patient,
and adjusted according to trough levels.
Neonates
IV: Loading dose of 15 mg/kg then
Preterm: 10 mg/kg/dose 24 hrly
Term: Week 1 of life: 10 mg/kg/dose 12 hrly
Week 2-4 of life: 10 mg/kg/dose 8 hrly
Severe infections: 15 mg/kg/dose
Nb: There is limited evidence behind dosing in preterm infants, and other centres use
alternative dosing protocols based on weight.
Infants and Children
IV: usual start dose 15mg/kg 6 hourly
Maximum recommended 2g/dose

Adjust according to trough levels. Range of dosing 10-20 mg/kg 6-8 hourly.
Patients in Intensive Care: Consider loading dose 20-30mg/kg, and earlier monitoring of
trough levels.

Monitoring - trough levels

Start

Sample

Repeat (For maintenance,

assuming normal renal
function)

Therapeutic Range

3rd to 5th dose

Trough

10-15 mg/L

Earlier if renal
impairment or load
given.

(immediately
before dose is due)

Every 3-5 days if dose

unchanged.

Cellulitis
15-20mg/L

Severe infection: bacteraemia,

pneumonia, osteomyelitis. me
known high MIC
Note: If trough levels are out of range, adjust either the dose or dosing interval. Recheck
trough level in 24 hours.

Adjusting Dose
Adjust according to trough levels. Usual range of dosing 10-20 mg/kg/dose 6-8 hourly.
General principles - Adjust one thing at a time.
Low trough levels: Increase dose and/or reduce interval (ie: give more frequently).
High trough levels: Increase interval (give less frequently) first, and/or reduce dose.
Consider starting with the following: (All levels are mg/L)
Level <5 increase dose by 50-100% (eg 10 to 20 mg/kg/dose).
Level 5-10 increase dose by 20%
Level >20 increase dose interval (eg from 6 to 8 hourly). Recheck level prior to next dose and
administer if within target range.
Consider discussing changes with local pharmacist/pharmacology team.
Additional Information:

Recommended trough levels have recently increased.

Trough levels of <10 may promote bacterial resistance.

Trough levels of 15-20 are thought to be most efficacious in the treatment of severe
infection; however there are no data on the safety of longer courses of vancomycin at
doses that achieve these levels. If a longer course of treatment is required, monitor
renal function closely, especially if on concomitant nephrotoxic medications.
Links: (RCH Intranet)
Paediatric Injectable Guidelines
Last updated April 2012