Neonatal Intensive Care Drug Manual

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Dosage / Interval

Loading dose 15 mg/kg over 1 hour, immediately followed by

Continuous infusion as per the table below:*

Serum Creatinine (micromol/L)	Corrected gestational age (CGA)	Dose
<40	≥40 weeks	2.1 mg/kg/hour (equivalent to 50 mg/kg/day)
<40	<40 weeks	1.7 mg/kg/hour (equivalent to 40 mg/kg/day)
40–60	All	1.25 mg/kg/hour (equivalent to 30 mg/kg/day)
>60	All	0.8 mg/kg/hour (equivalent to 20 mg/kg/day)

Example: 3kg baby at 41 weeks corrected gestational age with serum Cr 37 = 2.1 mg/kg/hour x 3.0 kg = 6.3mg/hour
Measure vancomycin concentration 24 hours (18–30 hours) and 48 hours after the commencement of infusion and then every 3 days.

See dose adjustment in Monitoring section.

Prescription order:

loading dose on ONCE ONLY section of the medication chart
Infusion dose in mg/kg/hour on fluid chart.

Dose adjustment

Therapeutic hypothermia - Refer to vancomycin intermittent version.

ECMO- Refer to vancomycin intermittent version.

Renal impairment – Refer to dosing section.

Hepatic impairment – Refer to vancomycin intermittent version.

Route

Preparation/Dilution

500mg VIAL

Add 10 mL of water for injection to the 500 mg vial to make a 50 mg/mL solution

FURTHER DILUTE

Draw up 5 mL (250 mg of vancomycin) of the above solution and add 45 mL glucose 5% or sodium chloride 0.9% to make a final volume of 50 mL with a final concentration of 5 mg/mL.

1g VIAL

Add 20 mL of water for injection to the 1g vial to make a 50 mg/mL solution

FURTHER DILUTE

Draw up 5 mL (250 mg of vancomycin) of the above solution and add 45 mL glucose 5% or sodium chloride 0.9% to make a final volume of 50 mL with a final concentration of 5 mg/mL.

Special circumstances To prepare 10 mg/mL concentration

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