{"id":2271,"date":"2023-06-25T17:55:01","date_gmt":"2023-06-25T17:55:01","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/vancomycin\/"},"modified":"2023-06-25T18:05:39","modified_gmt":"2023-06-25T18:05:39","slug":"vancomycin","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/vancomycin\/","title":{"rendered":"Vancomycin"},"content":{"rendered":"

<\/p>\n

CLINICAL USE<\/h3>\n

Antibacterial agent<\/p>\n

DOSE IN NORMAL RENAL FUNCTION<\/h3>\n

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

PHARMACOKINETICS<\/h3>\n
  • Molecular weight                           : 1449.3; (1485.7 as hydrochloride)<\/li>\n
  • %Protein binding                           : 10\u201350 (19 CKD 5)<\/li>\n
  • %Excreted unchanged in urine     : 80\u201390<\/li>\n
  • Volume of distribution (L\/kg)       : 0.47\u20131.1 (0.88 CKD 5)<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      : 6\/120\u2013216
    \n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : IV: 0.5\u20131 g every 12\u201324 hours Oral: dose as in normal renal function<\/li>\n
  • 10 to 20     : IV: 0.5\u20131 g every 24\u201348 hours Oral: dose as in normal renal function<\/li>\n
  • <10           : IV: 0.5\u20131 g every 48\u201396 hours Oral: dose as in normal renal function
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                : Not dialysed. Dose as in GFR <10 mL\/min<\/li>\n
  • HD                     : Not dialysed. Dose as in GFR <10 mL\/min<\/li>\n
  • HDF\/high flux   : Dialysed. See \u2018Other Information\u2019 CAV\/ VVh\/<\/li>\n
  • HD Dialysed. 1 g every 48 hours1 CVVhd\/ HDF Dialysed. 1 g daily and see \u2018Other Information\u2019.1
    \n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Ciclosporin: variable response; increased risk of nephrotoxicity<\/li>\n
  • Diuretics: increased risk of ototoxicity with loop diuretics Muscle relaxants: enhanced effects of suxamethonium<\/li>\n
  • Tacrolimus: possible increased risk of nephrotoxicity
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    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)<\/p>\n

    Route<\/h4>\n

    IV, oral<\/p>\n

    Rate of Administration<\/h4>\n

    Not faster than 10 mg\/minute<\/p>\n

    Comments<\/h4>\n

    Usual dilution is<\/li>\n

  • 10 to 20     : mg\/mL. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006.) USE IN<\/li>\n
  • CAPD                : PERITONITIS: 12.5\u201325 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 \u2014 IP on days 1, 7 and 14 in with a 6 hour dwell Patient weight <60 kg: 1.5 g IP on days \u2014 1, 7 and 14
    \n

    OTHER INFORMATION<\/h4>\n

    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 \u2014 serum levels at 24 hour intervals. When level<\/li>\n

  • <10           : mg\/L give another 1 g dose. Peak levels, 2 hours after dose, should be in range 18\u201326 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. *<\/li>\n","protected":false},"excerpt":{"rendered":"

    CLINICAL USE Antibacterial agent DOSE IN NORMAL RENAL FUNCTION IV:<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-2271","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/2271","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=2271"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/2271\/revisions"}],"predecessor-version":[{"id":2336,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/2271\/revisions\/2336"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=2271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=2271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=2271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}