Alternate Name(s):
Vancocin
Classification:
Antibiotic
Original Date:
March 1993
Revised Date:
July 2026
Indications:
- Confirmed infections with coagulase negative staphylococcus species (e.g. S. epidermidis)
- Empiric therapy for serious infections potentially due to methicillin-resistant S. aureus (MRSA)
- Confirmed infection for methicillin-resistant S. aureus (MRSA)
- Empirically for < 48 hours for suspected/confirmed meningitis until cultures available and re-assess
- Confirmed infections due to ampicillin-resistant enterococcus
Administration:
- IV intermittent infusion: over 1 hour
Dosage:
0 - 14 days:
- < 28 weeks GA: 20 - 22 mg/kg/dose Q24h
- 29-34 weeks GA: 20 - 22 mg/kg/dose Q18h
- > 35 weeks GA: 20 - 22 mg/kg/dose Q12h
> 14 days:
- < 28 weeks corrected GA: 20 - 22 mg/kg/dose Q18h
- 29 - 34 weeks corrected GA: 20 - 22 mg/kg/dose Q12h
- > 35 weeks corrected GA: 20 - 22 mg/kg/dose Q8-12h
Infant (corrected GA > 42 weeks and PNA > 4 weeks):
- 15 mg/kg/dose Q6h
Dosage adjustment required in renal impairment. Refer to available references or clinical pharmacist for dosage adjustment
Side Effects:
- Dermatologic: red man syndrome (associated with rapid infusion rate)
- Hematologic: eosinophilia, neutropenia
- Local: phlebitis
- Otic: ototoxicity associated with high drug levels
- Renal: nephrotoxicity (enhanced by aminoglycoside therapy)
Parameters to Monitor:
- Baseline serum creatinine and Pre level. Repeat both once weekly. Pre (Trough) levels > 15 mg/L should be monitored a minimum of twice weekly
- WBC
- Infusion site
Therapeutic drug levels:
- Serum Pre/trough Levels: 0 - 30 minutes before dose
- Initial level should be taken prior to the 4th or 5th dose
- Note: initial level should be taken prior to 2nd or 3rd dose if the dosing interval is >Q12H, or there is renal impairment
- When checking pre level, administer next dose as scheduled. Do not wait for level to be reported unless otherwise advised
- Pre (Trough) levels:
- 6 - 10 mg/L: Infections (e.g bacteremia) with coagulase negative staphylococci (e.g. S. epidermidis) including line infections.
- 10 - 15 mg/L: Skin and soft tissue infections (and others) caused by methicillin resistant Staphylococcus aureus (MRSA)
- Higher levels could be considered in other situations however risk of renal and other toxicity is increased. If prolonged treatment is anticipated, optimization of dosing should be done using AUC/MIC calculations (call ASP pharmacist).
- Post (Peak) levels: Not routine. This will be needed if AUC/MIC will be calculated.
Reconstitution and Stability:
IV intermittent infusion:
- Vancomycin 1000 mg vial
- Add 20 mL SWFI. Take 5 mL (250 mg) and add to 45 mL D5W
- Final concentration: 5 mg/mL
- Vancomycin 500 mg vial
- Add 10 mL SWFI. Take 5 mL (250 mg) and add to 45 mL D5W
- Final concentration: 5 mg/mL
Compatibility:
- Solutions Compatible: dextrose, saline, dextrose-saline combinations
- Y-site Compatible: calcium, fentanyl, heparin (in low concentrations of 0.5 to 1 unit/mL used to maintain IV line potency), midazolam, morphine, pancuronium, SMOF, TPN
Incompatible: dexamethasone, heparin (concentrations greater than 1 unit/mL), phenobarbital
References:
- Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Chambers HF. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children: Executive Summary. Clin Infect Dis. Feb 1 2011: 52 (3): 285-292
- Taketomo CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015.
- Trissel LA. Handbook on Injectable Drugs 19th Edition. Bethesda, Maryland; American Society of Health-System Pharmacists. 2017
- Rajon K, Vaillancourt R, Varughese N, Villarreal G. Vancomycin use, dosing and serum trough concentrations in the pediatric population: a retrospective institutional review. Pharmacy Practice 2017 Apr-Jun;15(2):887
- de Hoog M, Mouton JW, van den Anker JN. Vancomycin: pharmacokinetics and administration regimens in neonates. Clin Pharmacokinet. 2004;43(7):417-40.
- van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013; 57:734–744.
- Pham JT. Challenges of Vancomycin Dosing and Therapeutic Monitoring in Neonates. J Pediatr Pharmacol Ther. 2020;25(6):476-484.
- Ywaya R, Newby B. Assessment of Empiric Vancomycin Regimen in the Neonatal Intensive Care Unit. Can J Hosp Pharm. 2019 May-Jun;72(3):211-218.