Vancomycin PO

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Dose Notes
Clostridioides difficile infection: non-fulminant 125 mg PO QID No renal dose adjustment
Clostridioides difficile infection: fulminant 500 mg PO QID

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Dose Notes
Clostridioides difficile infection: non-fulminant 125 mg PO QID No dose adjustment in hemodialysis
Clostridioides difficile infection: fulminant 500 mg PO QID

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.

See IDMP guidelines for greater detail and vancomycin taper dosing: https://idmp.ucsf.edu/content/management-clostridium-difficile-infection-adults

PO vancomycin is NOT sufficiently absorbed to treat systemic infections