|Loading dose (for patients with known or suspected severe Staphylococcus aureus infection)¶||Load 20 to 35 mg/kg (based on actual body weight, rounded to the nearest 250 mg increment; not to exceed 3000 mg). Within this range, we use a higher dose for critically ill patients; we use a lower dose for patients who are obese and/or are receiving vancomycin via continuous infusion.|
|Initial maintenance dose and interval|| |
Typically 15 to 20 mg/kg every 8 to 12 hours for most patients (based on actual body weight, rounded to the nearest 250 mg increment).In general, the approach to establishing the vancomycin dose/interval is guided by a nomogram.Δ
|Subsequent dose and interval adjustments||Based on AUC-guided (preferred for severe infection) or trough-guided serum concentration monitoring.◊|
AUC: area under the 24-hour time-concentration curve.
* Refer to the UpToDate topic on vancomycin dosing for management of patients with abnormal kidney function.
¶ For patients with known or suspected severe S. aureus infection, we suggest administration of a loading dose to reduce the likelihood of suboptimal initial vancomycin exposure. Severe S. aureus infections include (but are not limited to) bacteremia, endocarditis, osteomyelitis, prosthetic joint infection, pneumonia warranting hospitalization, infection involving the central nervous system, or infection causing critical illness.
Δ If possible, the nomogram should be developed and validated at the institution where it is used to best reflect the regional patient population. Refer to the UpToDate topic on vancomycin dosing for sample nomogram.◊ Refer to the UpToDate topic on vancomycin dosing for discussion of AUC-guided and trough-guided vancomycin dosing. For patients with nonsevere infection who receive vancomycin for <3 days (in the setting of stable kidney function and absence of other risk factors for altered vancomycin kinetics), vancomycin concentration monitoring is often omitted; the value of such monitoring prior to achieving steady state (usually around treatment day 2 to 3) is uncertain.
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