Vancomycin
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 : 1449.3; (1485.7 as hydrochloride) %Protein binding : 10–50 (19 CKD 5) %Excreted unchanged in urine : 80–90 Volume of distribution (L/kg) : 0.47–1.1 (0.88 CKD 5) half-life – normal/ESRD (hrs) : 6/120–216 DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : IV: 0.5–1 g every 12–24 hours Oral: dose as in normal renal function 10 to 20 : IV: 0.5–1 g every 24–48 hours Oral: dose as in normal renal function <10 : IV: 0.5–1 g every 48–96 hours Oral: dose as in normal renal function DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD : Not dialysed. Dose as in GFR <10 mL/min HD : Not dialysed. Dose as in GFR <10 mL/min HDF/high flux : 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 : mg/mL. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006.) USE IN CAPD : 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 : 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. *
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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