Height: feet inches ( cm)
Weight: lbs ( kg)    100% IBW
Male Female Age:
Race: African/Caribbean Other
Ideal Body Weight: 110 lbs (50.0 kg)Dev
Adjusted Body Weight: 110 lbs (50.0 kg)
Body Mass Index: 21.5 kg/m²Quet
Body Surface Area: 1.45 m²Mos
Serum creatinine: mg/dL
Creatinine Clearance
Cockcroft-GaultCG 62.5 ml/min
(74.3 ml/min/1.73 m²)
The Cockcroft-Gault equation is used in most vancomycin dosing situations. An alternative (e.g., Salazar-Corcoran) might be considered in patients who are obese.
JelliffeJelliffe 62.2 ml/min
Salazar-CorcoranSC 72.2 ml/min
eGFR
Original MDRD Levey(1999) 84.2 ml/min/1.73 m²
Re-expressed MDRDLevey(2006) 79.1 ml/min/1.73 m²
refit MDRD, chronic kidney diseaseRule 95.5 ml/min/1.73 m²
refit MDRD, white + healthyRule 101.9 ml/min/1.73 m²
refit MDRD, quadraticRule 110.3 ml/min/1.73 m²
WrightW 76.4 ml/min
MartinM 69.3 ml/min
Suggested initial dosing & target trough levels
Nosocomial pneumonia15 mg/kg q12h 15-20 mcg/ml***ATS/IDSA
Endocarditis15 mg/kg q12h 10-15 mcg/mlAdjust for trough 30-45 mcg/mlAmerican Heart Association
***12-15 mg/kg5-15 mcg/ml Dosing interval determined by CrCl:
>80: q12h;
40-79: q24h;
25-29: q48h;
<25: dose by trough level		Columbia
Line-related infection (non-MRSA)
Non-CNS Abscess, drained
Febrile neutropenia, no pathogen identified		Loading dose: 20 mg/kg
Maintenance dose: 15 mg/kg		 8-15 mcg/mlDosing interval based on CrClKingston General
MRSA
Prosthetic joint infection
Osteomyelitis
S. Aureus pneumonia
CNS infection		15-20 mcg/ml
***Loading dose: 25 mg/kg
Maintenance dose: 19 mg/kg		Peak: 30 mcg/ml
Trough: 7.5 mcg/ml		Use nomogram to adjust dose interval
(~1440/CrCl, h)		Matzke
NondialysisLoading dose: 20-25 mg/kg10-15 mcg/mlPeak: 20-30 mcg/mlPierce
Pneumonia, dialysis15-20 mcg/ml
General15-18 mg/kg5 – 15 Initial dosing based on actual body weight:
Reduce dose by 250mg for weight over 120kg
Reduce dose by 500mg for weight over 200kg
Maximum dose 3000mg		 St Luke
Concurrent aminoglycoside15 mg/kg5-10
Infected Hardware
Diabetic Foot
Osteomyelitis
Endocarditis
Pneumonia &
concurrent aminoglycoside
Severe Infections
Community acquired pneumonia		 18 mg/kg10-15
Leukemia
Pneumonia
(ventilator-associated, hospital-acquired, healthcare-associated)		20 mg/kg15-20
Vancomycin Pharmacokinetic Parameters
(using Cockcroft-Gault)
Select Kel, h -1 t1/2, h Cl, ml/min Vd, L Comments Reference
*** *** *** *** Uses Salazar-Corcoran to determine CrCl for obese patients
Uses IBW to calculate Vd in patients >130% IBW		 Bauer
*** *** *** *** - Birt
*** *** *** *** Different pharmacokinetics for
patients with hematologic malignancies		 Buelga
*** *** *** *** Better predictor than Rushing in patients
weighing within 120% IBW (Lee et al)		 Leonard
*** *** *** *** Loading dose of 25 mg/kg;
subsequent doses of 19 mg/kg;
dosing interval nomogram provided		 Matzke
*** *** *** ***
*** *** *** *** Loading dose 20-25 mg/kg ABW Pierce
*** *** *** *** Suggests dose (mg/kg/24h) of
0.227*CrCl (ml/min/70kg) + 5.67		 Rodvold
*** *** *** *** Better predictor than Leonard in patients
weighing > 120% IBW (Lee et al)		 Rushing
*** *** *** *** Patients with serum creatinine < 1.5 mg/dL Vance-Bryan
*** *** *** ***
Selected kel (h-1): Selected Vd (L):
Goal Ctrough (mcg/ml):
Dosing
interval, h		68121618243648
Dose, mg************************
Infusion
time, min		***************************
Predicted
Ctrough, mcg/ml		***************************
Predicted
Cpeak, mcg/ml		***************************
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