In this section
Glycopeptide antibiotic, active against gram positive bacteria.
Usually reserved for treatment of methicillin-resistent staph
Potentially nephrotoxic, ototoxic.
Can cause red man
syndrome - flushing or rash on the upper body and
neck; muscle spasm of the neck and back. This is dose and infusion
related. Vancomycin should be infused over a minimum of 60 minutes,
and over 120 minutes for doses greater than 500mg, patients with
previous reactions, and neonates.
The dose chosen needs to be guided by the clinical picture and
age of patient, and adjusted
according to trough levels.
IV: Loading dose of 15 mg/kg then
Preterm: 10 mg/kg/dose 24 hrly
Term: Week 1 of life: 10 mg/kg/dose 12 hrly
Week 2-4 of life: 10 mg/kg/dose 8 hrly
Severe infections: 15 mg/kg/dose
Nb: There is limited evidence behind dosing in preterm infants,
and other centres use alternative dosing protocols based on
Infants and children
IV: usual start dose 15mg/kg 6 hourly
Maximum recommended 2g/dose
Adjust according to trough levels. Range of dosing 10-20 mg/kg
Patients in Intensive Care: Consider loading dose 20-30mg/kg,
and earlier monitoring of trough levels.
Repeat (For maintenance, assuming normal renal function)
3rd to 5th dose
Earlier if renal impairment or load given.
(immediately before dose is due)
Every 3-5 days if dose unchanged.
Severe infection: bacteraemia, endocarditis, pneumonia,
osteomyelitis. meningitis, known high MIC
Note: If trough levels are out of range, adjust either the dose
or dosing interval. Recheck trough level in 24 hours.
Adjust according to trough levels. Usual range of dosing 10-20
mg/kg/dose 6-8 hourly.
General principles - Adjust one thing at a time.
Low trough levels: Increase dose and/or reduce interval (ie:
give more frequently).
High trough levels: Increase interval (give less frequently)
first, and/or reduce dose.
Consider starting with the following: (All levels
Level <5 increase dose by 50-100% (eg
10 to 20 mg/kg/dose).
Level 5-10 increase dose by 20%
Level >20 increase dose interval (eg from 6
to 8 hourly). Recheck level prior to next dose and administer if
within target range.
Consider discussing changes with local pharmacist/pharmacology
Recommended trough levels have recently increased.
Trough levels of <10 may promote bacterial resistance.
Trough levels of 15-20 are thought to be most efficacious in the
treatment of severe infection; however there are no data on the
safety of longer courses of vancomycin at doses that achieve these
levels. If a longer course of treatment is required, monitor renal
function closely, especially if on
concomitant nephrotoxic medications.
Links: (RCH Intranet)
Paediatric injectable guidelines
Last updated April 2012