Vancomycin dosage

Vancomycin dosages should be infused during course of at least 1 hour to reduce risk of histamine-release "red man" syndrome. 

Vancomycin hydrochloridee 30 mg/kg per 24 hours IV in 2 equally divided doses Pediatric dose 40 mg/kg per 24 hours IV in 2-3 equally divided doses 6 IB Adjust vancomycin dosage to achieve 1 hour (peak) serum concentration of 30-45 mcg/mL and trough concentration of 10-15 mcg/mL (see text for vancomycin alternatives)... 

Empirical regimens containing Cefepime, ceftazidime, imipenem, meropenem Vancomycin dosages may be adjusted based on... 

Oxacillin-resistant strains Vancomycin6 doses Pediatic dose cefazolin 100 mg/kg per 24 hours IV in three equally divided doses gentamicin 3 mg/kg per 24 hours IV/ IM in three equally divided doses 30 mg/kg per 24 hours IV in two equally divided doses 6 weeks IB Adjust vancomycin dosage to achieve 1 -hour serum concentration of... 

Colestyramine binds with vancomycin within the gut, thereby reducing its biological activity (about tenfold according to in vitro studies). The combination of vancomycin and colestyramine used to be used in antibacterial-associated colitis (now no longer recommended) and to overcome this interaction it was suggested that a vancomycin dosage of 2 g daily should be used, and that administration of the vancomycin and colestyramine should be separated as much as possible to minimise their admixture in the gut. It is usually recommended that other drugs should be taken 1 hour before or 4 to 6 hours after colestyramine. 

Tediatric dose should not exceed that of a normal adult. dSee Table 71-3 for appropriate dosage of vancomycin. 

Penicillin G 24 million units/24 h IV in four to six equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin susceptible (minimum inhibitory concentration <0.1 mcg/mL) and does not produce/ lactamase. cGentamicin should be administered in close temporal proximity to vancomycin, nafcillin, or oxacillin dosing See Table 37-3 for appropriate dosage of gentamicin. 

Gentamicin should be administered in close proximity to vancomycin, nafdllin, or oxacillin dosing. See Table 37-3 for appropriate dosage of gentamidn. 

Dosage of gentamicin should be adjusted to achieve peak serum concentration of 3-4 mcg/mL and a trough concentration of less than 1 mcg/mL. See Table 37-3 for appropriate dosage of gentamicin. cPediatric dose should not exceed that of a normal adult. dSee text and Table 37-3 for appropriate dosing of vancomycin. 

For methicillin-resistant staphylococci, use vancomycin 0.5-1 g every 6-12 hours (pediatric dosing 40 mg/kg/day in divided doses) with dosage adjustments made for renal dysfunction. 

Anderson KE, Eliot LA, Stevenson BR, Rogers JA. Formulation and evaluation of a folic acid receptor-targeted oral vancomycin liposomal dosage form. Pharm Res 2001 18(3) 316-322. 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Pharmacokinetics Slow intravenous infusion is employed for treatment of systemic infections or for prophylaxis. Because vancomycin is not absorbed after oral administration, this route is only employed for the treatment of antibiotic-induced colitis due to Q difficile. Inflammation allows penetration into the meninges. Metabolism is minimal 90-100 % is excreted by glomerular filtration. [Note Dosage must be adjusted in renal failure since the drug will accumulate. Normal half-life is 6-10 hours compared to over 200 hours in end-stage renal disease.]... 

Vancomycin is known as a reserve antibiotic. It has been successfully used in patients with lactulose therapy failure. (160) Above all, vancomycin reduces the bacteroides population. The recommended dosage is 4 x 0.5 g/day. 

Darko W, Medicis JJ, Smith A, Guharoy R, Lehmann DF, Mississippi mud no more cost-effectiveness of pharmacokinetic dosage adjustment of vancomycin to prevent nephrotoxicity, Pharmacother, 2003,23(5) 643-50 197. 

Vancomycin Trough 5-15 mg/L Peak 25-40 mg/L Trough Immediately prior to dose Peak 60 min after a 60 min infusion With 3rd dose (when initially starting therapy, or after each dosage adjustment). For therapy less than 72 h, levels not necessary. Repeat drug levels if renal function changes... 

---