Vancomycin

Vancomycin

Indications

• Suspected or confirmed MRSA

Dosing

• Common dose
  • 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