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Standard dose: 15 mg/kg/dose. Dosing interval as per table below
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| bet | 623/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Standard dose: 15 mg/kg/dose. Dosing interval as per table below24
Method
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Interval
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Corrected Gestational Age/Postmenstrual Age
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Postnatal Age
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< 30+0 weeks
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0─2 days
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18 hourly
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< 30+0 weeks
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3+ days
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12 hourly
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30+0─36+6 weeks
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0─14 days
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12 hourly
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30+0─36+6 weeks
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15+ days
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8 hourly
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37+0─44+6 weeks
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0─7 days
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12 hourly
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37+0─44+6 weeks
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8+ days
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8 hourly
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≥ 45+0 weeks
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0+ days
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6 hourly
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Severe sepsis: Consider giving a loading dose of 20 mg/kg/dose in suspected severe sepsis including MRSA, bone infection, meningitis, endocarditis. However, data in neonates are limited.
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Dose adjustment
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Renal Impairment:
For infants with renal impairment, consider using an antibiotic without nephrotoxicity in consultation with an infectious diseases specialist.
If vancomycin is used, perform a trough level before the 2nd dose.
Adjust the dosage interval5, 21 to achieve a trough level 10─20 mg/L (higher trough level 15─20 mg/L in severe sepsis). Repeat trough level before the next dose after each dosage adjustment or before every 3rd dose for infants within the target range.
Hepatic impairment: Not applicable.
Therapeutic hypothermia: Measure trough concentration prior to 2nd dose.27
ECMO: Current evidence is insufficient to recommend a specific dose adjustment.
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Maximum dose
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Not applicable
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Total cumulative dose
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Not applicable
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Route
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IV
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Preparation
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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 2 mL (100 mg of vancomycin) of the above solution and add 18 mL glucose 5% or sodium chloride 0.9% to make a final volume of 20 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 2 mL (100 mg of vancomycin) of the above solution and add 18 mL glucose 5% or sodium chloride 0.9% to make a final volume of 20 mL with a final concentration of 5 mg/mL.
Fluid restriction To prepare 10 mg/mL concentration
Vancomycin can be diluted to 10 mg/mL solution, however this dilution increases the risk of infusion-related events (see adverse reactions).
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 4 mL (200 mg of vancomycin) of the above solution and add 16 mL glucose 5% or sodium chloride 0.9% to make a final volume of 20 mL with a final concentration of 10 mg/mL.
To prepare 10 mg/mL concentration
1g VIAL
Add 20 mL of water for injection to the 1g vial to make a 50 mg/mL solution
Further Dilute
Draw up 4 mL (200 mg of vancomycin) of the above solution and add 16 mL glucose 5% or sodium chloride 0.9% to make a final volume of 20 mL with a final concentration of 10 mg/mL.
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Administration
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IV infusion over ONE hour.
Adequately flush the intravenous lines before and after administration of vancomycin.
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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 trough vancomycin concentration immediately prior to 3rd dose with the exception of:
1. <29+0 CGA weeks – before 2nd dose,
2. therapeutic hypothermia – before 2nd dose and
3. renal impairment – before 2nd dose, but refer to renal impairment section below.
Check concentration prior to the 4th dose after any change in dose or frequency.
Once target trough levels are reached, measure trough levels every 3 days prior to consecutive doses.
More frequent monitoring may be required in renal impairment, infants receiving other nephrotoxic drugs or suspected severe sepsis.
If a peak concentration is required to guide dosing, perform this 1 hour after completion of infusion, and target a peak concentration 20-40 mg/L. [22]
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