Vancomycin IV

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Dosing: Adult Antimicrobial Dosing, Non-dialysis

 

Body Weight**

CrCl (mL/min) < 60 kg 60-80 kg 81-100kg > 100kg
>90 mL/min (complicated* infection & age < 65) 750mg IV q8h 1000mg IV q8h 1250mg IV q8h 1500mg IV q8h
>90 mL/min (complicated* infection & age > 65 or uncomplicated infection & age < 65) 1000mg IV q12h 1250mg IV q12h 1500mg IV q12h 1750mg IV q12h
50-90 mL/min 750mg IV q12h 1000mg IV q12h 1250mg IV q12h 1500mg IV q12h

Complicated* & age <65

1000mg IV q8h

15-49 ml/min 750mg IV q24h 1000mg IV q24h 1250mg IV q24h 1500mg IV q24h
<15 ml/min not on dialysis 10-15mg/kg IV x1 then redose according to levels

*Complicated infections: CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis

**Use Total Body Weight for patients <120% of Ideal Body Weight. Use Adjusted Body Weight for patients >120% of Ideal Body Weight.

Recommend loading dose (20-25 mg/kg IV x1) for serious infections including CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication

Intermittent Hemodialysis

Continuous Hemodialysis
All Indications 15 - 20 mg/kg IV x 1 then 500 mg IV post-HD only 10 - 15 mg/kg IV q24h

Contact pharmacy for maintenance dose and consider vancomycin per pharmacy (UCSF only).

See Vancomycin Dosing and Monitoring page for more detail.

Round to nearest 250mg increment. Max: 2g/dose

*If Total BW > 1.2 times Ideal BW, use Adj BW

Recommend loading dose (20-25 mg/kg IV x1) for serious infections including CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis