Vancomycin

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Vancomycin

Indication
  • Empirical antibiotic with gentamicin for line sepsis (review ongoing need when culture results are available)
  • MRSA infections
  • All other indications as per NHS Lothian Antimicrobial guideline

Dosage and Administration
  • Body weight > 50kg: 1g over 2 hours
  • Body weight ≤ 50kg: 750mg over 1.5 hours
(Please use dry weight. This is particularly important in patients with oedema)
  • To be given as an IV infusion only. Rate should not exceed 10mg/min
**Do NOT use Vancomycin Calculator on the Intranet**
  • Please administer via a central venous catheter or a large vein if only peripheral access is available.

Concentration and Strength
  • Max concentration after dilution is 5mg/ml

Stability
  • Please use reconstituted solution as soon as possible.

Reconstitution instructions
  • Reconstitute a 1g vial with 20ml of water for injection or a 500mg vial with 10ml of water for injection. Further dilute a 1g or 750mg dose in 250ml of sodium chloride 0.9% or glucose 5%.
  • For patients with a fluid restriction, a minimum volume of 50ml diluent for each 250mg can be used ie 1g in 200ml or 750mg in 150ml.

Additional Information
  • Haemodialysis (HD) removal: No
  • Haemodiafiltration (HDF) removal: Yes Therefore, patients on HDF should be switched to HD when receiving vancomycin
  • Dose should be administered in the last 2 hours or 1.5 hours (depending on dose) of HD

Monitoring
Inpatient Outpatients
  • A level should be taken daily including non-dialysis days unless otherwise instructed by senior medical staff
  • Dose to be administered if level is <20mg/l
  • Take a level pre-dialysis
  • Dose to be administered if level is <20mg/l
For NEW patients starting on vancomycin, a pre-dose level is not required prior to the first dose
Written by: Jin Hah, Renal Pharmacist, Dr Eoin O’Sullivan, Specialist Registrar
Reviewed by: Dr Iain MacIntyre, Consultant Nephrologist
Date written: October 2017
Review date: October 2019

 

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