Adult Dosing
Severe systemic infections caused by susceptible organism
- 500 mg IV q6 hrs or 1 g IV q12 hrs
- Should be administered at no more than 10mg/min over a period of at least 60 minutes
Orbital cellulitis [Non-FDA Approved]
- 30-60 mg/kg/day IV divided q6-8h
Epiglottitis [Non-FDA Approved]
Pediatric Dosing
Severe Systemic Infections
Neonates
- Initial dose 15 mg/kg IV followed by 10mg/kg every 12 hrs for neonates in the 1st wk of life, and every 8 hrs thereafter up to the age of 1 month
- Each dose should be administered over a period of at least 60 minutes
Pediatric patients
- 10 mg/kg per dose given every 6 hrs
- Each dose should be administered over a period of at least 60 minutes
Orbital cellulitis [Non-FDA Approved]
- 30-60 mg/kg/day IV divided q6-8h
Epiglottitis [Non-FDA Approved]
- 15 mg/kg IV load, then 10 mg/kg q 12 hrs
Bacterial Meningitis [Non-FDA approved]
- 60 mg/kg/day IV divided q6 hrs
Pediatrics Pneumonia [Non-FDA Approved]
- Neonates: Initial dose 15 mg/kg IV followed by 10 mg/kg every 12 hrs for neonates in the first wk of life, and every 8 hrs thereafter up to the age of 1 month
- Infants/Children: 10 mg/kg/dose q6 hrs
[Outline]
Renal Dose Adjustment for Adults (Based on CrCl)
- Renal impairment: Initial dose is
15 mg/kg. Monitor serum level for deciding maintenance dosage in patients with renal impairment
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- For IV administration only; not for intrathecal or intraperitoneal administration
- Do not exceed concentrations of more than 5 mg/mL or 10 mg/min; risk of infusion-related events. Rapid bolus administration may be associated with exaggerated hypotension, including shock, and rarely, cardiac arrest, with or without maculopapular rash over face, neck, upper chest, and extremities (Red Man or Redneck syndrome)
- Tissue irritant; give by secure IV route. May minimize thrombophlebitis by slow IV administration
- Do not use to treat methicillin-sensitive Staphylococcus aureus because it is inferior to antistaphylococcal penicillins and first generation cephalosporins
- May cause ototoxicity; more common in patients given excessive doses, hearing impairment, concurrent aminoglycosides/ototoxic agents
- Reversible neutropenia has been reported in patients receiving vancomycin
- Monitor renal function at baseline, continue periodically if renal impairment or concomitant aminoglycosides
- Consider serial audiometry especially if concurrent aminoglycosides/ototoxic agents are given
- Monitor vancomycin serum concentrations closely
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Rapid IV infusion or bolus administration
- Hearing impairment
- Concurrent nephrotoxic agents
- Concurrent ototoxic agents
- Elderly patients
Pregnancy Category:C
Breastfeeding: Limited information indicates that vancomycin is excreted in breastmilk in low levels and it would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 6 September 2010).
