[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-294325-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-294325-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","adult-intravenous-vancomycin-dosing-and-monitoring-guidelines","Adult Intravenous Vancomycin Dosing and Monitoring Guidelines","","Guidelines for adult intravenous vancomycin dosing and therapeutic drug monitoring, covering loading and maintenance strategies based on actual body weight, renal function, and target trough ranges. The document provides dosing tables by weight and dosing intervals using estimated creatinine clearance, with adjustments for elderly, debilitated patients, and dialysis considerations. It specifies monitoring schedules, timing for trough draws, desired serum concentrations, nephrotoxicity cautions, and guidance for continuous infusion conversion, dosing targets (AUC/Css), and clinical scenarios.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/adult-intravenous-vancomycin-dosing-and-monitoring-guidelines/294325/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/adult-intravenous-vancomycin-dosing-and-monitoring-guidelines/294325.png","ImageObject",300,407,{"name":42,"@type":43},"Emma Wilson","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-22","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",22,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How is the adult loading dose of vancomycin determined for severe sepsis, shock, or deep-seated infection?","Question",{"text":63,"@type":64},"Administer a loading dose of 20 mg/kg IV as the first dose for severe sepsis/shock and/or suspected or confirmed deep-seated infections.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What dosing interval should be used based on estimated creatinine clearance for traditional versus high dosing?",{"text":68,"@type":64},"Traditional dosing uses goal trough 10–15 mcg/mL with intervals such as q12h when CrCl > 65 and q24h when CrCl 30–65; dialysis patients require contacting the service pharmacist. High dosing uses goal trough 15–20 mcg/mL with q8h when CrCl > 100 and q12h when CrCl 66–100, with further reductions or pharmacist guidance for lower CrCl.",{"name":70,"@type":61,"acceptedAnswer":71},"When should vancomycin trough levels be drawn and how often should monitoring continue?",{"text":72,"@type":64},"Troughs are drawn just before the 4th dose of a new regimen (or prior to the 3rd dose if the interval is ≥24 hours or renal function is changing) and within 30 minutes before the next scheduled dose. At minimum, levels should be obtained by 72 hours and at least weekly thereafter, with more frequent monitoring for many patients; chemistries and CBCs should also be checked at least weekly.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},294325,1789682391,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":80,"read_time":144},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","ADULT INTRAVENOUS VANCOMYCIN DOSING AND MONITORING GUIDELINES  \nDOSE: Adult dose: (based on actual body weight (ABW))*,^ :  \n12.5 to 15 mg/kg (round off to nearest 250 mg increment, to max dose of 1500mg; see dosing table)  \n* If ABW is > 30% ideal body weight (IBW), then use adjusted body weight = IBW + 0 .4(Total body weight-IBW) IBW Males = 50 kg + 2.3 kg for each inch > 60 inches IBW Females = 45 kg + 2.3 kg for each inch > 60 inches  \n^ Give a Loading Dose of 20mg/kg IV x 1 (1st dose) for severe sepsis/shock and/or suspected or confirmed deep-seated infections.  \n\n| VANCOMYCIN DOSES\u003Cbr>Traditional Dosing: goal trough 10-15 mcg/mL  High Dosing: goal trough 15-20 mcg/mL Weight (kg) Maintenance Dose ~ 12.5 to 15mg/kg / dose Maintenance Dose ~ 15mg/kg / dose |  |  |\n| --- | --- | --- |\n| > 90 | 1250 | 1500 |\n| 76-90 | 1000 | 1250 |\n| 55-75 | 1000 | 1000 |\n| 45-55 | 750 | 750 |\n\n-Contact your service pharmacist for information on morbidly obese or markedly fluid-overloaded patients  \nINTERVAL:  \n\n| VANCOMYCIN DOSING INTERVAL BASED ON ESTIMATED CrCL* |  |  |  |\n| --- | --- | --- | --- |\n| Traditional dosing: Goal Tr = 10-15 mcg/ml CrCL (ml/min) Dosing Interval (hrs) |  | High Dosing: Goal Tr = 15-20 mcg/ml CrCL (ml/min) Dosing Interval (hrs) |  |\n| > 65 | q12h | > 100 | q8h |\n| 30-65 | q24h | 66-100 | q12h |\n| \u003C 30 or dialysis | contact pharmacist | 30-65 | q24h |\n|  |  | \u003C 30 or dialysis | contact pharmacist^ |\n\n* CrCL = Creatinine Clearance (Calculation): use minimum SCr of 1mg/dl in elderly and cachectic patients; Tr = trough ^ Dosing recommendations in hemodialysis are presented on the next page  \nNeed to reduce total daily dose for debilitated or elderly patients-no more frequent than q24h dosing for >79yrs  \nMONITORING:  \nUsually only vancomycin troughs are needed. Random levels may be obtained on patients with poor renal function who only receive intermittent or post-dialysis dosing. At minimum, levels should be obtained for all patients by 72 hours of therapy and at least weekly thereafter. Many patients will require more frequent monitoring. Chemistries and CBCs should also be checked at least weekly. Monitoring in hemodialysis is presented on the next page.  \nEarly serum level testing to ensure adequate dosing:   Conditions requiring early and more frequent lab testing:  \n- Central nervous system infections - Rapidly changing renal function  \n- S. aureus sepsis w/ clinical instability - Poor renal function or on dialysis  \n- Osteomyelitis - Co-administration with nephrotoxic drugs  \n- Ventilator associated & hospital-acquired pneumonia - Target trough level of 15 – 20mcg/ml  \n- Endocarditis - For information on appropriate use of levels in dialysis,  \n- Persistently positive gram-positive bacteremia please see next page; call your service-based pharmacist  \nThe service pharmacist can assist with questions regarding vancomycin dosing, monitoring or level interpretation.  \nWhen to draw levels:  \nTrough: just before 4th dose of a new regimen (prior to 3rd dose for dosing intervals ≥ 24 hours or changing renal function)  \n- Trough levels should be obtained within 30 minutes before the next scheduled dose.  \n- Weekly vancomycin levels should be obtained for long-term vancomycin use with stable renal function.  \nDesired Levels:  \nTraditional dosing: 10-15 mcg/ml (to achieve concentration ≥ 4 x MIC of directed pathogen at the site of infection) High dosing: 15-20 mcg/ml (deep-seated gram-positive infections, CNS infections, or as recommended by ID  \n*** Caution*** Troughs > 15mcg/ml have been associated with higher rates of nephrotoxicity  \nVancomycin Continuous Infusion (CI)  \nA. Background  \n1. May be renal protective compared to troughs of 15-20mcg/ml via intermittent dosing  \n2. Effective method to achieve adequate levels in pts with high elimination rates (i.e. ClCr > 120 ml/min, e.g. burn, TBI, severe trauma)  \n3. Review need for continued vancomycin therapy (for 4 days or more)  \n4. Confirm central venous access and m","cbCaivNVTDSd3w5F","https://ap.wps.com/l/cbCaivNVTDSd3w5F","pdf",765844,"English","# Adult Intravenous Vancomycin Dosing and Monitoring Guidelines\n## Dose and Loading Dose\n## Maintenance Dose and Weight-Based Table\n## Dosing Interval Based on Estimated CrCl\n## Monitoring and When to Draw Levels\n## Desired Level Targets and Nephrotoxicity Caution\n## Vancomycin Continuous Infusion (CI)\n## Indications and Therapeutic Targets\n## Converting Intermittent to Continuous Dosing\n## Vancomycin New Start Loading and Cpeak","[{\"question\":\"How is the adult loading dose of vancomycin determined for severe sepsis, shock, or deep-seated infection?\",\"answer\":\"Administer a loading dose of 20 mg/kg IV as the first dose for severe sepsis/shock and/or suspected or confirmed deep-seated infections.\"},{\"question\":\"What dosing interval should be used based on estimated creatinine clearance for traditional versus high dosing?\",\"answer\":\"Traditional dosing uses goal trough 10–15 mcg/mL with intervals such as q12h when CrCl \\u003e 65 and q24h when CrCl 30–65; dialysis patients require contacting the service pharmacist. High dosing uses goal trough 15–20 mcg/mL with q8h when CrCl \\u003e 100 and q12h when CrCl 66–100, with further reductions or pharmacist guidance for lower CrCl.\"},{\"question\":\"When should vancomycin trough levels be drawn and how often should monitoring continue?\",\"answer\":\"Troughs are drawn just before the 4th dose of a new regimen (or prior to the 3rd dose if the interval is ≥24 hours or renal function is changing) and within 30 minutes before the next scheduled dose. At minimum, levels should be obtained by 72 hours and at least weekly thereafter, with more frequent monitoring for many patients; chemistries and CBCs should also be checked at least weekly.\"}]","Adult Intravenous Vancomycin Dosing and Monitoring Guidelines | PDF",15]