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

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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.

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Concentration and Strength

• Max concentration after dilution is 5mg/ml

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Stability

• Please use reconstituted solution as soon as possible.

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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.

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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

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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