Vancomycin dosing

Oxaclllln-resistant strains Vancomycin doses Pediatic dose cefazolln 100 m kg per 24 hours IV in three equally divided doses gentamicin 3 m kg per 24 hours IV/ IM in three equally divided doses 30 m kg per 24 hours IV in two equally divided doses 6 weeks IB Adjust vano)mycin dosage to achieve 1-hour serum ronc tration of... 

In a prospective study to determine if standardized vancomycin doses could produce adequate serum concentrations in 25 full-term neonates with sepsis 13 had adequate peak vancomycin serum concentrations (20-40 mg/ml) and one had a peak concentration with a risk of ototoxicity (over 40 qg/ml) (130). Only 12 had adequate trough concentrations (5-10 mg/ml) and 7 had a risk of nephrotoxicity (over 10 qg/ml). There was no significant difference between peak or trough concentrations and good or bad clinical outcomes. 

Vancomycin requires multicompartment models to completely describe its serum-concentration-versus-time curves. However, if peak serum concentrations are obtained after the distribution phase is completed (usually V2 to 1 hour after a 1-hour intravenous infusion), a one-compartment model can be used for patient dosage calculations. Also, since vancomycin has a relatively long half-life compared with the infusion time, only a small amount of drug is eliminated during infusion, and it is usually not necessary to use more complex intravenous infusion equations. Thus simple intravenous bolus equations can be used to calculate vancomycin doses for most patients. Although a recent review paper questioned the clinical usefulness of measuring vancomycin concentrations on a routine basis, research articles" " have shown potential benefits in obtaining vancomycin concentrations... 

Brown DL, Mauro LS. Vancomycin dosing chart for use in patients with renal impairment. Am J Kidney Dis 1988 11 15-19. 

Duffull, S. B. et ah. Efficacies of different vancomycin dosing regimens against Staphylococcus aureus determined with a dynamic in vitro model, Antimicrob. Agents Chemother., 38(10) 2480-2482, 1994. 

If no adequate dosage form is available, it is possible to use oral liquids rectally, eye drops in the ear or a sometimes costly injectable solution orally (e.g. clonidine) and, less frequently, by respiratory routes (e.g. gentamicin, vancomycin). Doses may need to be adapted due to differing... 

Hall RG, Hazlewood KA, Brouse SD, GirUiano CA, Haase KK, Frei CR, et al. Empiric guideUne-recommended weight-based vancomycin dosing and nephrotoxicity rates in patients with methicUUn-resistant Staphylococcus aureus bacteremia a retrospective cohort study. BMC... 

Ariano, R. E., Fine, A., Sitar, D. S., Rexrode, S., and Zelenitsky, S. A. (2005). Adequacy of a vancomycin dosing regimen in patients receiving high-flux hemodialysis. Am. J. Kidney Dis. 46, 681. 

In Vivo Properties. The efficacy of dalbaheptides has been assessed ia various models of experimental septicemia ia mice. In general there was good correlation between the ED qS (effective doses which prevent death ia 50% of test animals) and the MICs on test strains. Teicoplanin was very effective, ED q values ranged from 0.11 to 0.72 mg/kg sc administration for septicemias caused by S. pyogenes S. pneumoniae and S. aureu whereas for vancomycin ED qS were from 0.58 to 7.2 mg/kg (33). Eremomycin (52) had therapeutic activity 2—3 times greater than vancomycin. Therapeutic indices... 

Clinical Use. Vancomycin and teicoplanin as fomiulated dmgs are lyophilized powders to be reconstituted with sterile water for injection. Vancomycin hydrochloride [1404-93-9] is presented in vials of 500 mg that give 100—200 mL solution of pH 2.5—4.2. It is administered by slow (60 min) infusion at a dose of 500 mg every 6 h or 1 g every 12 h/d. The teicoplanin contains the five factors (87%) plus 13% of the pseudoaglycone T-A3-1. It is presented in vials containing 200 mg of lyophili ed power that after dissolution with 3 mL of solvent gives a solution at pH 7.5. The dose regimen is 200—800 mg/d by iv bolus adrninistration. 

The nurse should administer each IV dose of vancomycin over 60 minutes Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock. When giving the drug IV, the nurse closely monitors the infusion rate and the patient s blood pressure. The nurse reports any decrease in blood pressure or reports of throbbing neck or back pain. These symptoms could indicate a severe adverse reaction referred to as "red neck or "red man syndrome. 9/mptoms of this syndrome include a sudden and profound fall in blood pressure, fever, chills paresthesias and erythema (redness) of the neck and badk. 

Obtain serum drug levels for aminoglycosides and/or vancomycin and perform pharmacokinetic analysis. Adjust the dose, if needed, according to the parameters in Table 13-2. Obtain follow-up trough levels at weekly intervals or sooner if renal function is unstable. Follow serum creatinine levels if renal function is unstable. Hearing tests may be scheduled yearly or per patient preference. 

Vancomycin 20-30 mg/kg IV per day in divided doses every 8-12 hours 30-45 mg/kg IV per day in divided doses every 6-8 hours 60 mg/kg IV per day in divided doses every 6 hours... 

Traditionally, high-dose penicillin G was the treatment standard for meningococcal disease. However, increasing penicillin resistance requires that third-generation cephalosporins now be used for empirical treatment until in vitro susceptibilities are known.23 Patients with a history of type I penicillin allergy or cephalosporin allergy may be treated with vancomycin. Treatment should be continued for 7 days, after which no further treatment is necessary. 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Dexamethasone therapy may reduce antibiotic penetration, so antimicrobial drug dosing may have to be increased (especially vancomycin) to achieve adequate CSF levels. Serum levels of vancomycin should be measured and doses titrated to ensure adequate CNS concentrations. Evaluate whether intraventricular or intrathecal antibiotics are indicated. 

For enterococci, it is imperative to determine species and antibiotic susceptibilities. If the organism is susceptible to penicillin and vancomycin, treatment may consist of high-dose penicillin G, ampicillin, or vancomycin plus gentamicin (see Table 71-6). Treatment length is usually 4 to 6 weeks, with the aminoglycoside used over the entire course. As resistance develops to penicillin, ampicillin and vancomycin remain treatment options. Once the isolate becomes resistant to ampicillin, vancomycin is considered the treatment of choice. 

For penicillin-allergic (nonanaphylactoid type) patients cefazolin 6 g/24 hours IV in 3 equally divided doses 6 IB Consider skin testing for oxacillin-susceptible staphylococci and questionable history of immediate-type hypersensitivity to penicillin cephalosporins should be avoided in patients with anaphylactoid-type hypersensitivity to P-lactams vancomycin should be used in these cases ... 

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)... 

Penicillin C 24 million units/24 hours IV in 4 to 6 equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin-susceptible (minimum inhibitory concentration less than or equal to 0.1 mcg/mL) and does not produce P-lactamase. cGentamicin should be administered in close temporal proximity to vancomycin, nafcillin, or oxacillin dosing. 

Gentamicin should be administered in close proximity to vancomycin, nafcillin, or oxacillin dosing. cPediatric dose should not exceed that of a normal adult. 

MRSA Enterococcus spp. Vancomycin Adult 10-15 mg/kg per dose IV every 8-12 hours Pediatric6 40 mg/kg per day IV in divided doses every 6 hours Linezolid Adult 600 mg IV/oral every 12 hours Pediatric6 10 mg/kg per dose IV/oral every 8 hours ... 

Adult 2 g IV every 4-6 hours Pediatric6 100-200 mg/kg per day IV in divided doses every 4-6 hours Vancomycin... 

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