Vancomycin
Loading Dose
(Maximum 3 g)
Seriously ill patient: 25-30 mg/kg
Renal insufficiency: 15-20 mg/kg
Peritoneal dialysis 10-15 mg/kg
CrCl > 130: 15 mg/kg (ICU only)
Conditions | Dose |
|---|---|
CrCl > 90 ml/min | 15-20 mg/kg q12h to 15 mg/kg q8h |
CrCl 51 - 89 ml/min | 15-20 mg/kg q12h |
CrCl 30 - 50 ml/min | 15 mg/kg q12h to 20 mg/kg q24h |
CrCl 10 - 29 ml/min | 10-15 mg/kg q24h to 15 mg/kg q48h |
CrCl < 10 ml/min or AKI | 15 mg/kg x1 then dose by level |
Hemodialysis: | |
: Low permeability membrane | 25 mg/kg then 7.5 mg/kg AD |
: High permeability membrane | 25 mg/kg then 10 mg/kg AD |
CAPD | 7.5 mg/kg q 48-96h |
CRRT | 7.5-10 mg/kg q 12h |
SLED | 20-25 mg/kg then 15mg/kg AD |
*AKI (KDIGO, RIFLE, AKIN classification):
I: SCr increase by 0.3 ml/dl in 48 h or increase 50% from baseline.
II: Cr increase 25-50%
III: Urine output < 0.5 ml/kg/h > 6 h
- Use their actual body weight to calculate medication loading and maintenance doses.
The maximum loading dose is limited to 3,000 mg.
The maximum maintenance dose is limited to 4,500 mg/day.
The Cockcroft-Gault equation may yield inaccurate estimates based on a patient's body weight and BMI. By including additional height information, we can calculate BMI and provide a modified estimate and range.
- Underweight: For a BMI of 18.5 or less, use the actual body weight for calculations.
- Normal Weight: Use the ideal body weight for calculations.
- Overweight/Obese: For a BMI of 25 or higher, use the adjusted body weight for calculations.
Calculation Steps
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