Lecture 19 Vancomycin TDM

Question 1

What is the empiric dosing for vancomycin in adults?

Answer 1

A: Loading Dose: 25-30 mg/kg using ABW, get pt to steady state right away

B: choose a Maintenance Dose: 15 mg/kg/dose using ABW (usually capped at 2 g/dose)

C: pick a Dosing Interval: numerous nomograms exist, typically based off renal clearance (CrCl),, D: DRAW a level at steady state

E: MONITOR for clinical improvement

F: MONITOR for toxicity (SCr, ototoxicity, neutrophil count)

Question 2

When might a higher vancomycin target of 15-20 mg/L be indicated?

Answer 2

CNS infections, pneumonia, infective endocarditis, bacteremia, deep-seated infections

may consider 10-15 for other infections (ex. uncomplicated UTI)

Question 3

What is the ‘easy way/formula’ for adjusting vancomycin dose?

Answer 3

Dose(new) = (C(desired)/C(measured)) x Dose (old)