Vancomycin
MRSA coverage, Severe skin/soft tissue infections, Endocarditis, Meningitis (empiric)
Indications
- MRSA coverage
- Severe skin/soft tissue infections
- Endocarditis
- Meningitis (empiric)
Adult dosing
- standard: dose: 25; unit: mg/kg; route: IV; interval: q8-12h, target AUC/MIC 400-600; weightBased: true; maxDose: 3000; maxDoseAbsolute: true; meningitis: dose: 30; unit: mg/kg; route: IV loading dose; weightBased: true; maxDose: 3000; maxDoseAbsolute: true
Pediatric dosing
- standard: dose: 15; unit: mg/kg; maxDose: 750; maxDoseAbsolute: true; route: IV; interval: q6h; weightBased: true; pedNote: Max 3g/day total; meningitis: dose: 20; unit: mg/kg; maxDose: 1000; maxDoseAbsolute: true; route: IV; interval: q6h; weightBased: true
Clinical pearls
- Loading dose 25-30 mg/kg (actual body weight) for serious infections
- Infuse over at least 1 hour per 1g to avoid Red Man Syndrome
- AUC/MIC-guided dosing preferred over trough-based dosing (2020 guidelines)
- Red Man Syndrome is a rate-related histamine reaction, not a true allergy
Source and review
- IDSA Vancomycin Therapeutic Monitoring Guidelines 2020. Last reviewed: 2024-09-15