Intermittent dosing preferred. Consider continuous infusion in critically ill patients or when unable to achieve therapeutic vancomycin levels with intermittent dosing — seek specialist advice.
Switching from intermittent vancomycin dosing to a continuous infusion:. Commence at the dose equivalent to the total daily dose administered in the previous 24 hour period. Dose adjustment If the steady state level is outside of the therapeutic range, adjust the dose according to the following formula:. The next dose is then given 6 hours after the loading dose. Use actual body weight for dose calculations, including obese patients, up to the maximum recommended doses. Take a trough level before the 2nd dose is due and with hold the dose until the result is known.
Seek specialist advice for subsequent dosing. Vancomycin levels should be repeated until there are two consecutive levels within target range. After this, vancomycin levels can be repeated every 3 days or whenever there is a significant change in bodyweight, serum creatinine or if the dose has been adjusted. Vancomycin is potentially nephrotoxic and ototoxic especially when used in combination with other nephrotoxic or ototoxic agents eg aminoglycosides and in renal impairment.
These features develop quickly and usually subside within an hour but may persist for several hours in some cases. The Royal Children's Hospital Melbourne.
Rapid infusion may cause red man syndrome see Adverse Effects section below Vancomycin levels are required to ensure that the target therapeutic range is achieved see Therapeutic Drug Monitoring section below Continuous infusions of vancomycin in infants aged 0 to 90 days are associated with earlier and improved attainment of target concentrations compared with intermittent dosing Dose Patient age Dosing regimen 0—90 days Continuous infusion recommended.
If the steady state level is within target range, continue vancomycin infusion and repeat steady state level 18—30 hours after the first level. Seek specialist advice for subsequent dosing Trough level samples are to be taken approximately 30 minutes before the dose is due.
Inpatients with normal renal function, the next dose of vancomycin should be given at the scheduled time before the level is known. Monitor for nephrotoxicity. Adverse Effects Vancomycin is potentially nephrotoxic and ototoxic especially when used in combination with other nephrotoxic or ototoxic agents eg aminoglycosides and in renal impairment.
Reference List Antibiotic Therapeutic Guidelines. Vancomycin is also used when patients are intolerant or allergic to beta-lactam antibiotics. Vancomycin has been associated with nephrotoxicity and ototoxicity, although it appears that many of these reports reflected impurities in early formulations.
Monitoring of vancomycin-related nephrotoxicity is recommended only for patients with reduced renal function, those receiving aggressive or prolonged vancomycin regimens, or those at high-risk including patients comedicated with other nephrotoxic agents. Trough concentrations are recommended for therapeutic monitoring of vancomycin, preferably acquired at steady-state just before fourth dose.
To avoid development of resistance, vancomycin trough levels should remain above Complicated infections require higher target levels, typically Peak concentrations do not correlate well to efficacy or nephrotoxicity, but may be useful for pharmacokinetic analyses eg, area under the curve: AUC studies or for select patients. Trough levels correlate better with efficacy than peak levels, with target trough levels of As with any assay employing mouse antibodies, the possibility exists for interference by human antimouse antibodies HAMA in the sample, which could cause falsely lowered results.
Am J Health Syst Pharm. Mayo Clinic.
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