Monitoring
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Renal function, full blood count, hearing function and serum vancomycin concentrations.
Target trough concentration 10─20 mg/L
Aim for higher trough level of 15─20 mg/L in suspected severe sepsis e.g., MRSA, bone infection, meningitis, endocarditis.
Measure vancomycin concentration 24 hours (18–30 hours) after commencement of infusion AND 24 hours after each change of infusion rate.
Level 1
24 hours after commencement
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Dose
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Level 2
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Consecutive levels
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15-25mg/mL
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Same
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48 hours
After first level
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Day 6, day 9, day 12, day15
Every 3 days
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<15mg/mL
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Increase
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24 hours
After dose adjustment
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48 hours if targeted level achieved followed by every 3 days
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>25mg/mL
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Decrease
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24 hours
After dose adjustment
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48 hours if targeted level achieved followed by every 3 days
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Repeat steady state level more frequently if
10% change in body weight OR
25% change in serum creatinine OR
age-related dose adjustment OR
interruption in IV infusion OR
infant receives indomethacin.
If vancomycin level <15 or >25 mg/L: Adjust dose using below calculation:
Adjusted dose (mg/kg/hour) = last maintenance dose (mg/kg/hour) x (20mg/mL ÷ last vancomycin concentration)
For example:
Last dose was 2.1 mg/kg/hour and the last vancomycin concentration was 12 mg/L:
Adjusted dose: 2.1 mg/kg/hour x (20 mg/L ÷ 12 mg/L) = 3.5 mg/kg/hour
Last dose was 2.1 mg/kg/hour and the last vancomycin concentration was 28 mg/L:
Adjusted dose: 2.1 mg/kg/hour x (20 mg/L ÷ 28 mg/L) = 1.5 mg/kg/hour
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