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Dosage and Administration:

Infusion-related events are related to both concentration and rate o administration of vancomycin. Concentrations of not more than 5 mg/mL and rates of no more than 10 mg/mL may be used; use of such higher concentrations may increase the risk of infusion-related events. Infusion-related events may occur, however, at any rate or concentration.

Patients with Normal Renal Function

Adults – The usual daily intravenous dose is 2g divided either as 500 mg every 6 ours of 1g every 12 hours. Each dose should be administered at no more than 10 mg/min or over a period of at least 60 minutes, whichever is longer. Other patient factors, such as age, or obesity, may call for modification of the usual intravenous daily dose.

Children – The usual intravenous dosage of vancomycin hydrochloride is 10 mg/kg pr dose given every 6 hours. Each dose should be administered over a period of at least 60 minutes.

Infants and Neonates – In neonates and young infants, the total daily intravenous dosage may be lower. In both neonates and infants, an initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours for neonates in the 1st week of life and every 8 hours thereafter up to the age of 1 month. Each dose should be administered over 6 minutes. Close monitoring of serum concentrations of vancomycin may be warranted in these patients.

Patients with Impaired Renal Function and Elderly Patients

Dosage adjustment must be made in patients with impaired renal function. In premature infants and the elderly, greater dosage reductions than expected may be necessary because of decreased renal function. Measurement of vancomycin serum concentrations can be helpful in optimizing therapy especially in seriously ill patients with changing renal function. Vancomycin serum concentrations can b determined by use of microbiologic assay, radioimmunoassay, fluorescence polarization immunoassay, fluoroscence immunoassay, or high-pressure liquid chromatography. If creatinine clearance can be measured or estimated accurately, the dosage for most patient with renal impairment an be calculated using the following table. The dosage of vancomycin hydrochloride per day in mg is about 15 times the glomerular filtration rate in mL/min:

DOSAGE TABLE FOR VANCOMYCIN
IN PATIENTS WITH IMPAIRED RENAL FUNCTION
(Adapted from Moellering et. at)

The initial dose should be no less than 15mg/kg, even in patients with mild to moderate renal insufficiency. The table is not valid for functionally anephric patients. For such patients, an initial dose of 15mg/kg of body weight should be given to achieve prompt therapeutic serum concentrations. The dose required to maintain stable concentrations is 1.9 mg/kg/24 in. In patients with marked renal impairment, it may be more convenient to give maintenance doses of 250 to 1,000mg once every several days rather than administering the drug on a daily bases. In anuria, a dose of 1,000 mg every 7 to 10 days has been recommended. When only the serum creatinine concentration is known, the following are only estimates.The creatinine clearance should be measured promptly.

Women: 0.85 x above value

The serum creatinine must represent a steady state of renal function. Otherwise, the estimated value for creatinine clearance. Is not valid. Such a calculated clearance is an overestimate of actual clearance in patients with conditions: (1) characterized by decreasing renal function, such as shock, severe heart failure, or oliguria; (2) in which a normal relationship between muscle mass and total body weight is not present, such as obese patients or those with liver disease, edema, or ascites, and (3) accompanied by debilitation, malnutrition, or inactivity.

The safety and efficacy of vancomycin administration by the intrathecal (intralumbar or intraventricular) route have not been assessed. Intermitted infusion is the recommended method of administration.