Renal dosing of Vancomycin

This page was downloaded with the free trial version of Inspyder Web2Disk.
To remove this message, please purchase the full version from our website.
Inspyder Website

Vancomycin: Dose adjustment for renal impairment.

Cockcroft-Gault CrCl estimates (using the creatinine clearance calculator) should be used for drug dosing rather than the automated MDRD eGFR produced by the clinical chemistry laboratory available on NOTIS.

Crcl (ml/min)	Dose
20 – 50 (or >65 yrs if Crcl >50ml/min)	1g od. Check pre dose level before third dose.
10 – 20	1g every 48 hours. Check pre dose level before second dose.
<10	1g stat (or 15mg/kg up to max 2g). Check level after 4-5 days. ONLY re-dose when level <12mg/L. If deep seated infection when <15mg/L.

Whilst patients are on Vancomycin please ensure urine output is monitored.

Close monitoring of serum levels recommended and adjust dose accordingly.

Refer to renal pharmacist for advice on dosing in haemodialysis and peritoneal dialysis.

Refer to critical care pharmacist for advice on dosing in CVVH.

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.