Vancomycin Dosing Calculator
This calculator may be used to calculate vancomycin dosing. The calculations utilized to arrive at these dosages are described below.
Vancomycin at OrlandoHealth is dosed based upon the following premises:
- Loading dose: 20 mg/kg of current body weight (maximum dose of 2500 mg).
- Maintenance dose of 15 mg/kg of current body weight (maximum of 2000 mg).
- Dosages are rounded to the nearest 250 mg increment.
- Dosing intervals are based upon the patient's estimated serum creatinine clearance (Cockcroft-Gault method).
- >90 mL/min - Every 8 hours
- 60-89 mL/min - Every 12 hours*
- 40-59 mL/min - Every 24 hours
- 30-39 mL/min - Every 24 to 36 hours
- 16-29 mL/min - Every 36 to 48 hours
- <15 mL/min, hemodialysis - Give 1 dose; redose when level below recommended trough
- *The initial dosing interval may need to be more frequent (e.g., every 6 or 8 hours) in certain patients (e.g., hyperdynamic states, younger adults, meningitis)
- The target Vancomycin trough level is 10-15 mcg/mL for mild-to-moderate infection.
- The target Vancomycin trough level is 15-20 mcg/mL for severe infection (including but not limited to sepsis, pneumonia, abscess, endocarditis, osteomyelitis, deep sternal wound infection, meningitis).
- Peak concentration levels are not routinely recommended, but may be useful for pharmacokientic / pharmacodynamic assessments (lack of clinical reponse, obesity). When obtained they should be drawn 1 hour after the end of the infusion.
- Timing and frequency of trough levels
- Empiric therapy planned for fewer than 5 days - No trough necessary
- Directed therapy - Obtain trough with the 3rd or 4th dose
- Duration of therapy greater than 5 days - Obtain trough every 5 to 7 days
- Creatinine clearance less than 20 mL/min or patient receiving hemodialysis - Obtain trough every 3 to 7 days
- (Trough levels should be obtained immediately prior to the administered dose)
- Dose Adjustments
- Should be made based upon the obtained serum levels
- No adjustment is necessary if the level is < 10% above the goal trough range (e.g., a level of 22 mcg/dL for a goal range of 15-20 mcg/dL)
- Serum creatinine should be checked every 3 to 4 days unless the patient is on hemodialysis or more frequently if acute changes in renal function or clinical status are identified.