Hospital Pharmacists Information System
Walnuthealthcare@gmail.com
  • Home
    • British Clin. Pharmacy
    • Clinical Pharmacy
    • NewEngland Pharmacy
    • Toledo Univ Pharmacy
    • University of Alberta
    • Patient Advocate
    • Umesh VRIP Videos
    • Patient Information H/D >
      • Mayo Clinic >
        • Want to Live Longer or Even Forever? >
          • An Ancient Solution to Live Longer
          • Artificial Intelligence
          • Explanation of Telomeres
          • Famous People eating Plant Based Diet >
            • Dr. Atkins
            • Dr. Esselstyn
            • Dr. Fuhrman
            • Dr. Fung
            • Dr. Gerson
            • Dr. Greger
            • Dr. Mercola
            • Dr. McDougall
            • Dr. Ornish
            • Dr. westerdahl
          • Health Care in USA
          • Opioid Overdose Crisis
    • Webmaster Rx >
      • Jokes are good for health >
        • Jokes in English >
          • Jokes in Hindi
      • Password Protected
    • WU Pharmacy College
  • Adult Rx
    • Adult IV Drug List
    • Anticoagulation
    • Antibiotics
    • Blood & Blood Factors
    • Cardiovascular Care
    • Contrast Media
    • Drug Comparison
    • Drug List
    • Diabetic Care
    • Elderly Patients
    • Frequently Used Drugs
    • Online Rx Resources
    • Renal Drugs Info
    • Respiratory Drugs
    • Safe Handling of Drugs
    • Special IV Remarks
  • Calculators
    • Medical Calculators
    • Nursing Calculators
    • Pharmacy Calculators
  • INFO Book
    • Clinical Pharmacy
    • Disability Info Help
    • Diseases by Food >
      • Heart Attack >
        • AFIB Medications
        • Atrial Fibrillation
        • Arrhythmias
        • Arrhythmia Treatment
        • BP Medications
        • CPR
        • EKG
        • Heparin/Anticoagulants
        • Hypertension
        • Heart Medications
      • Stroke
      • Alzheimer’s Disease
      • Arthritis
      • Diverticulitis >
        • Diverticulitis
        • Diabetes mellitus (DM) >
          • blood Sugar
      • DVT and P. Embolism
      • Gastrointestinal
      • Anti Aging
      • Healthy Lifestyle
      • Healthy Eating by CDC
      • Eating Healthy Foods
      • Ellagic Acid >
        • Black Walnut
        • Juglone
      • Micro/Macro Nutrients
      • Turmeric (Curcumin)
    • Lectures by Experts >
      • Atkin Diet
      • Caldwell
      • Dean Ornish
      • Deepak Chopra
      • Joseph M. Mercola
      • Gerson Therapy
      • John Fuhrman
      • John Westerdahl
      • McDougall
      • Michael Greger
    • Health Care Education
    • Healthy-Eating-Lifestyle
    • Pharmacology
    • Renal Failure
    • Pharmacokinetics
    • Sleep
    • Stability of Drugs
  • Web/Links
    • Disease Prevention
    • Health Information
    • For Consumers
    • For Professional
    • Medical Encyclopedia
    • Nursing Websites
    • Pediatric Websites
    • Physician Websites
  • Ped/Women
    • Pediatric Drug List >
      • Pediatric IV Drug List
    • Vancomycin Peds
  • Publications
    • Anticoagulation
    • QTc Prolongation
    • Pharmacy Resources
    • Pharmacy Protocols
  • SelfCare Rx
    • Blood Pressure Care
    • Diabetic Care
    • Disability Information
    • God and Science
    • Health & Longevity
    • Heart Care
    • Inflammation Care
    • Living as Senior
    • Resources-Prof. Fink
    • Retirement
    • Videos made by WHC
    • Weight Management
  • Blood Pressure
    • BP Prevention
    • BP Reduction >
      • Renal >
        • Dialysis
        • Drug clearance
        • Disease prevention
        • Kidney stones
        • Renal acidosis
        • Renal failure
    • Hypotension
  • Diabetic
    • Diabetic cure
    • Diabetic foot
    • Atherosclerosis
    • Diabetes prevention
  • Diet
  • Excercise
  • Heart
    • Heart care lifestyle
    • Reversing disease
  • Inflammation
    • Body inflammation
    • Digestive Tract
    • Inflammation by alcohol
    • Joint inflammation
    • Knee inflammation
    • Pelvic Inflammation
    • Prevention
    • vascular inflammation
  • Stroke
    • Stroke treatment
    • Atrial fibrillation
    • Stroke prevention
  • Wt Manage.
    • Weight loss by diet
  • Clinical Pharmacy
    • Ambulatory Care Rx
    • Anticoagulation Rx
    • Adult Pts Care >
      • Administration-IV Drugs
    • Cardio/Critical Care >
      • Respiratory Rx Care
    • Diabetic Pts Care >
      • Diabetes Education
    • Geriatric Pts Care Rx
    • Neonate Pts Care
    • Infactious Diseases
    • Nutrition Support Rx
    • Nuclear Pharmacy
    • Oncology Pharmacy
    • Pain Management
    • Pediatric Pts Care >
      • Administration-IV Drugs
    • Pharmacotherapy >
      • Antimicrobial
      • HIV/AIDS Pts Care
      • Clinical Pharmacology
      • Wellness Center
    • Psychiatric Pt Care
    • Renal Rx Care
    • Woman Pts Care
    • WEBMASTER Rx
  • Clinical BioPharma
  • Pharmacokinetics
  • Pharmacy Information
    • ACLS Guideline
    • BLS Guideline
    • Antimicrobial
    • Credentialing Rx
    • Credentialing Tech
    • Emergency
    • EMR Related
    • Procedures
    • Phone Numbers
    • Poison Information
    • Skill Training
  • Pharmacy Prococols
    • Antimicrobial
    • Aminoglycosides
    • Heparin Protocol
    • Pharmacy Protocols
    • Vancomycin
Vancomycin

SUGGESTED TARGET VANCOMYCIN LEVELS 

Vancomycin Pre-Level 5-15 mg/L
(goal ~ 10 mg/L)
 

Vancomycin Pre-Level 15-20 mg/L 

  • Skin and soft tissue infection not due to MRSA 
  • Uncomplicated catheter-associated bacteremia due to coagulase-negativeStaphylococcus* 
  • Urinary tract infection (catheter-associated; rule out bacteremia) 
  • CNS infection 
  • Deep-seated or sequestered infection (e.g. abscess) 
  • Endocarditis 
  • Osteomyelitis 
  • MRSA bacteremia, pneumonia or skin and soft tissue infection 
  • MSSA bacteremia (penicillin allergic pt) 
* uncomplicated refers to lack of septic thrombosis, tunnel infection, or port 
  abscess for tunnelled or implantable catheters
 

METHOD 1 

Quick and simple way to dose vancomycin

      1. Loading dose (LD, see below)

  •                    750mg            for 40>     to =<60 kg
  •                  1000mg            for 60>     to =<80 kg
  •                  1250mg            for >80     to =<100 kg
  •                  1500mg            for >100   to =<120 kg
  •                  1750mg            for >120   to =<140 kg 
  •                  2000mg            for>140 kg
      2. Select one of the following intervals based on serum creatinine and Give 1000mg if LD 1250mg, give 1250mg if LD 1500mg, and give 1500mg if LD 2000mg.  Pharmacist may readjust the dosing intervals based on pk calculations from serum levels.

Initial dosing intervals in hrs before serum levels are analyzed 

Serum Creatinine (µmol/L)

(For umol/dL divide by 100) Age Group (years) 

20-29

30-39

40-49

50-59

60-69

70-79

40-60

8

8

12

12

12

18

61-80

8

12

12

12

18

18

81-100

12

12

12

18

18

18

101-120

12

12

18

18

18

24

121-140

12

18

18

18

24

**

141-160

18

24

24

24

**

**

161-180

24

24

**

**

**

**

181-200

24

**

**

**

**

**

METHOD 2 Renal Dosing

Rough estimates (Ideally, base initial regimen on patient-specific pharmacokinetic dosing calculations.):

  • [CRCL >60 ml/min]: Start with 1-1.5g see method 1 or 10-20 mg/kg/dose q12h.
  • [ 40-60 ]: Start with 1-1.5g see method 1 or 10-20 mg/kg/dose q24h.
  • [<40 ]: Start with 1-1.5g see method 1 or 10-20 mg/kg/dose q36 to 48h. May need serum level
METHOD 3  Renal Dosing

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)

  • 1 - 1.5g LD see method 1. then 1g every 24 hours. Check pre dose level before third dose.
10 – 20

  • 1-1.5g LD see method 1 and then 1g every 48 hours. Check pre dose level before second dose.
<10

  • 1-1.5g LD stat see method 1 (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.
INITIAL DOSING RECOMMENDATIONS FOR PEDIATRIC PATIENTS

1.     Vancomycin should be infused intravenously over one hour to avoid blunted peaks especially in the setting of meningitis.   It maynot be given IM.

2.     Loading dose (optional):   An initial loading dose of 15mg/kg may be used to insure immediate attainment of a therapeutic peak concentration (>20 mcg/ml).

3.     Maintenance dose:  Physicians may order “vancomycin per pharmacy” in addition to using the dosing recommendations below.

Patients > 1 week through 1 month chronological age and >36 weeks post conceptual age (PCA) with normal serum creatinine (SCr ≤ 0.6)*

Indication

Initial Dosing

Pneumonia, endocarditis, meningitis, osteomyelitis

45 mg/kg/day divided every 8 hours

All other indications

30 mg/kg/day divided every 8 hours

*Patients < 1 week of age regardless of gestational age, refer to the NICU guideline. 

Patients 1 through 3 months of age and > 36 weeks PCA with normal serum creatinine (SCr < 0.9)

Indication

Initial Dosing

Pneumonia, endocarditis, meningitis, osteomyelitis

60 mg/kg/day divided every 6 hours

All other indications

40-50 mg/kg/day divided every 6 hours

Patients 3 months through 12 years of age with normal renal function (SCr < 0.9)

Indication

Initial Dosing

Pneumonia, endocarditis, meningitis, osteomyelitis

60 mg/kg/day divided every 6 hours

All other indications

40-50 mg/kg/day divided every 6 hours

Patients >12 years of age with normal renal function (SCr <0.9)

Indication

Initial Dosing**

Pneumonia, endocarditis, meningitis, osteomyelitis

60 mg/kg/day divided every 8 hours

Or call pharmacy for a dosage assessment,

especially for obese patients

(Maximum dose = 1250-1500mg every 8-12 hours)

All other indications

40 mg/kg/day divided every 8 hours

**The typical adult maximum dose for adult patients is 1250 - 1500mg every 8 – 12 hours or 4000mg/day.  Consider using adult pharmacokinetics in larger and/or older pediatric patients.   Refer further to the LBMMC Vancomycin Guideline.

DISCLAIMER

The information contained on this website is for informational purposes only, and should not be used to replace professional medical advice. Visitors to the website are responsible for how they chose to utilize this content.

This information should not be considered complete, nor should it be relied on in diagnosing or treating a medical condition. Content on this website does not contain information on all diseases, ailments, physical conditions or their treatment.

It is best to seek advice and attention from your physician or qualified healthcare professional. Always consult your physician before beginning a new treatment, diet or fitness program.

Walnut HealthCare and the participating hospitals do not endorse nor have responsibility for the contents of any other websites linked to or from www.walnuthealthcare.com or www.walnuthealthcare.org.

Please note that all inpatient pharmacists at the participating hospitals are trained and contiuously recertified before they can use any of the protocols per pharmacy on patients.  Per Pharmacy Protocols are those Protocols which are approved by hospital’s P&T committee and to which the pharmacy adheres in order to provide medications to patients in a safe, efficient and ethical manner.