Vancomycin Dosing Guidance_BNHFT_March_2010

Protocol for the administration of Vancomycin IV
(Adults)
Vancomycin Dosing Guidance
Renal Function Dosage
Dosage
Dosage
(CrCl)
≥ 100kg
99 - 50kg
< 50kg
>100 ml/min 1.5g BD 1.25g BD 1.25g BD
61-100 ml/min 1.25g BD 1g BD 750mg BD
51-60 ml/min 1g BD 750mg BD 1g OD
20-50 ml/min 1g OD 1g OD 750mg OD
20 Omit one dose and move down
one stage in dosing regimen
16-20 Move down one stage in dosing regimen
10-15 ON TARGET repeat trough level twice weekly

Protocol for the administration of Vancomycin IV
(Adults)
Creatinine Clearance (CrCl)
The eGFR appears with biochemistry results and can be used
as a quick estimate for calculating initial doses.
A more accurate estimate should be obtained using the
Cockcroft-Gault equation (N = 1.23 males, 1.03 females):
CrCl (ml/mn) = N x [140 – age (years)] x Wt* (kg)
Serum creatinine (µmol/L)
Produced by the Antibiotic Management Team –2010, ratified March 2010
Dr JA Cepeda, Consultant Microbiologists & T Keyser, Antibiotic Pharmacist Review March 2012