In this section
Continuous infusion recommended.
Intermittent dosing preferred. Consider continuous infusion in critically ill patients or when unable to achieve therapeutic vancomycin levels with intermittent dosing – seek specialist advice.
Corrected Gestational Age (CGA)
Continuous infusion dose
Infants and children >90 days of age
Seek specialist advice
Switching from intermittent vancomycin dosing to a continuous infusion:
Commence at the dose equivalent to the total daily dose administered in the previous 24 hour period
Initiating vancomycin treatment with a continuous infusion:
Loading dose 20–30 mg/kg is given over 1 hour followed by a continuous infusion.
The usual starting dose is 60 mg/kg/day.
Therapeutic drug monitoring
Target steady state level: 15–25 mg/L young infants (0–90 days of age)
20-25 mg/L children (>90 days of age)
If the steady state level is outside of the therapeutic range, adjust the dose according to the following formula:
Adjusted dose (mg/day) = last maintenance dose (mg/day) x (target level/last vancomycin level)
Eg if a 3 kg infant is prescribed 50 mg/kg/day and has a vancomycin level of 13 mg/L, the adjusted dose = 150 mg x (20/13) = 230 mg/day
Neonates: 15 mg/kg/dose intravenously (IV) at a frequency according to the table below:
29 to 35 weeks
36 to 44 weeks
Infants and children
Usual starting dose: 15 mg/kg/dose (maximum 750 mg) every 6 hours.
In children with severe sepsis, consider a loading dose of 30 mg/kg (maximum 1500 mg). The next dose is then given 6 hours after the loading dose.
Use actual body weight for dose calculations, including obese patients, up to the maximum recommended doses.
Therapeutic drug monitoring
Target trough level: 10 – 15 mg/L (15–20 mg/mL for severe infections)
Timing of initial vancomycin trough levels
Before the 5th dose
Before the 4th dose
Before the 3rd dose
Before the 2nd dose
Take a trough level before the 2nd dose is due and withhold the dose until the result is known. Seek specialist advice for subsequent dosing
Vancomycin levels should be repeated until there are two consecutive levels within target range. After this, vancomycin levels can be repeated every 3 days or whenever there is a significant change in bodyweight, serum creatinine or if the dose has been adjusted.
Suggested dosage adjustment
Increase the dose or dosing frequency.
Reduce the dose or dosing frequency or withhold the dose. Monitor for nephrotoxicity.
Dilute to 5 mg/mL or weaker and infuse over at least 60 minutes (maximum rate 10 mg/minute)
Concentrations up to 10 mg/mL may be administered via a central line if necessary, the risk of infusion reactions is increased with higher concentrations (see Adverse Effects section below).
Vancomycin is potentially nephrotoxic and ototoxic especially when used in combination with other nephrotoxic or ototoxic agents (eg aminoglycosides) and in renal impairment.
Rapid infusion may cause red man syndrome:
These features develop quickly and usually subside within an hour but may persist for several hours in some cases
If symptoms of red man syndrome occur:
Child requiring care beyond the level of comfort of the local hospital
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650
Last Updated November, 2019