Vancomycin Hydrochloride

Adults: For vancomycin hydrochloride in adults, the recommended concentration is no more than 5 mg/ml, with a rate of no more than 10 mg/min. In selected patients who need fluid restriction, a concentration up to 10 mg/ml may be used. For patients with normal renal function, the usual daily dose in adults is 2 gm, given in 4 or 2 divided doses. Children have a total daily dose of 40 mg/Kg, given in 4 divided doses. For infants and neonates, an initial dose of 15 mg/Kg is suggested, followed by 10 mg/Kg every 12 hours in the first week, then every 8 hours up to 1 month. Patients with impaired renal function, and elderly patients, need a dosage adjustment. In premature infants and the elderly, the dose may have to be reduced more than you'd expect, because their renal function is declining. If creatinine clearance (CrCl) can be measured or estimated accurately, the dose for most patients with renal impairment can be worked out from the following chart. At CrCl 100 ml/min the vancomycin dose is 1545 mg/24 h, at 90 ml/min it is 1390 mg/24 h, at 80 ml/min 1235 mg/24 h, at 70 ml/min 1080 mg/24 h, at 60 ml/min 925 mg/24 h, at 50 ml/min 770 mg/24 h, at 40 ml/min 620 mg/24 h, at 30 ml/min 465 mg/24 h, at 20 ml/min 310 mg/24 h, and at 10 ml/min 155 mg/24 h. The initial dose should not be less than 15 mg/kg, even in patients with mild to moderate renal insufficiency. The chart is not valid for functionally anephric patients. These patients should get an initial dose of 15 mg/kg of body weight to reach therapeutic serum concentrations promptly. The dose needed to keep concentrations stable is 1.9 mg/kg/24 h. Individual maintenance doses of 250 to 1,000 mg are convenient, so in patients with marked renal impairment 1 dose may be given every several days instead of daily. In anuria, a dose of 1000 mg every 7 to 10 days has been recommended. Intermittent infusion is the recommended method of administration, and intraperitoneal administration is not recommended. For the capsule, the usual daily dosage in adults with antibiotic-associated pseudomembranous colitis produced by C. difficile (Vancomycin Hydrochloride Capsules, Product Monograph, Page 8 of 24) and with staphylococcal enterocolitis is 125 to 500 mg taken orally every 6 to 8 hours for 7 to 10 days. In pediatrics, the usual daily dosage is approximately 40 mg/kg in 3 or 4 divided doses, taken orally for 7 to 10 days. The total daily dosage should not exceed 2 g.