Vancomycin.txt

CLINICAL USE

Antibacterial agent

DOSE IN NORMAL RENAL FUNCTION

IV: 1 g every 12 hours Oral: 125 mg or 500 mg 4 times daily (Higher dose for resistant cases of Clostridium difficile)

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 1449.3; (1485.7 as hydrochloride)

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 10–50 (19 CKD 5)

%Excreted unchanged in urine &nbsp &nbsp : 80–90

Volume of distribution (L/kg) &nbsp &nbsp &nbsp : 0.47–1.1 (0.88 CKD 5)

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp : 6/120–216

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : IV: 0.5–1 g every 12–24 hours Oral: dose as in normal renal function

10 to 20 &nbsp &nbsp : IV: 0.5–1 g every 24–48 hours Oral: dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : IV: 0.5–1 g every 48–96 hours Oral: dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp : Dialysed. See ‘Other Information’ CAV/ VVh/

HD Dialysed. 1 g every 48 hours1 CVVhd/ HDF Dialysed. 1 g daily and see ‘Other Information’.1

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Ciclosporin: variable response; increased risk of nephrotoxicity

Diuretics: increased risk of ototoxicity with loop diuretics Muscle relaxants: enhanced effects of suxamethonium

Tacrolimus: possible increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

10 mL water for injection per 500 mg vial, then dilute 1 g to 250 mL with sodium chloride 0.9% (50 mL if giving centrally)

Route

IV, oral

Rate of Administration

Not faster than 10 mg/minute

Comments

Usual dilution is

10 to 20 &nbsp &nbsp : mg/mL. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006.) USE IN

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp: PERITONITIS: 12.5–25 mg/L per bag (see local protocol.) Various other regimens used in PD ranging from IV dosing to high dose stat IP use Some units use the following: Patient weight >60 kg: stat dose of 2 g — IP on days 1, 7 and 14 in with a 6 hour dwell Patient weight <60 kg: 1.5 g IP on days — 1, 7 and 14

OTHER INFORMATION

Second line to metronidazole in treatment of pseudomembranous colitis Not absorbed via oral route at low doses but monitor plasma levels at higher doses Injection solution may be given orally; however, oral capsules available Alternative Dosage Adjustment In Moderate And Severe Renal Impairment: Give 1 g loading dose and monitor — serum levels at 24 hour intervals. When level

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mg/L give another 1 g dose. Peak levels, 2 hours after dose, should be in range 18–26 mg/L. Some units use a 500 mg loading dose Anephric/dialysis patients usually need 1 g once or twice weekly . In HDF higher doses are required; possible doses are 1 g initially followed by 500 mg every dialysis for 3 dialysis sessions. *

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