15mg/kg/dose with timing based on renal function (q12h if normal)
Titrate based on serum trough drawn within hour before fourth dose
Target trough
10-15 for low-risk infections
15-20 for high-risk infections such as osteomyelitis, meningitis, and bacteremia
Adverse Reactions
Renal Failures
Risk factors
Prolonged courses >21 days
Higher trough
Concomitant nephrotoxic medication
Older age
CKD/AKI
Liver disease
Peritonitis
Neutropenia
Male sex
Mechanism of injury: oxidative stress in the proximal tubular cells
Red Man Syndrome
Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping
Very high incidence previously
Histamine-mediated
Can decrease dose or prolong infusion, prophylactic antihistamines
References
^Michael J Rybak, Jennifer Le, Thomas P Lodise, Donald P Levine, John S Bradley, Catherine Liu, Bruce A Mueller, Manjunath P Pai, Annie Wong-Beringer, John C Rotschafer, Keith A Rodvold, Holly D Maples, Benjamin M Lomaestro. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy. 2020. doi:10.1093/ajhp/zxaa036.
