Vancomycin IV

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

Use Vancomycin Dosing Calculator (Excel file) for more precise dose calculation and level-based adjustment.

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

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

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

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