Vancomycin
Loading Dose
Seriously ill patient: 25-30 mg/kg
Renal insufficiency: 15-20 mg/kg
Peritoneal dialysis 10-15 mg/kg
CrCl
(ml/min)
>90
51-89
30-50
10-29
Intermittent HD
CRRT
CAPD
Vancomycin
(Maintanance)
Initial:
15-20 mg/kgx1 dose
Maintanance:
Dose by level
<10 or AKI*
10-15 mg/kg q 24 h
to
15mg/kg q 48 h
15 mg/kg q 12 h
to
20mg/kg q 24 h
15-20 mg/kg q 12 h
15-20 mg/kg q 12 h
to
15 mg/kg q 8 h
15 mg/kg x1 dose
then
dose by level
Initial:
10-15 mg/kgx1 dose
Maintanance:
Dose by level
Initial:
15-20 mg/kgx1 dose
Maintanance:
Dose by level
*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.
- Cockcroft-Gault Formula for calculating CrCl utilizes Ideal body weight in its calculations.
- To calculate the ideal body weight, you can use the Devine equation for individuals taller than 5 feet (the program has already converted this to centimeters).
IBW = 50 + [2.3 x (height,inches -60)] for male
IBW = 45.5 + [2.3 x (height,inches -60)] for female
- If BMI is greater than 30/m², switch to using Adjusted Body Weight for calculating CrCl.
- If the loading dose exceeds 3000 mg or the maintenance dose exceeds 4500 mg per day, it will be limited to a maximum.
