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Vancomycin: Parenteral dosing, monitoring, and adverse effects in adults

Richard H Drew, PharmD, MS, FCCP, FIDP
George Sakoulas, MD
Section Editor
David C Hooper, MD
Deputy Editor
Elinor L Baron, MD, DTMH


Vancomycin is a glycopeptide antibiotic used intravenously for treatment of patients with suspected or proven invasive gram-positive infections, including methicillin-resistant Staphylococcus aureus (MRSA).

Appropriate dosing and administration of vancomycin requires consideration of the infection site, disease severity, patient weight, renal function, and pathogen susceptibility [1,2]. Careful attention to individualizing therapy and use of serum concentration monitoring are important for optimizing vancomycin dosing [3-6].

Issues related to vancomycin dosing and serum concentration monitoring will be reviewed here. Issues related to vancomycin hypersensitivity are discussed separately. (See "Vancomycin hypersensitivity".)


Clinical approach — The clinical approach to vancomycin dosing is based on the type and severity of infection, patient weight, and renal function [3-7]:

For patients with deep-seated infection (including bacteremia, endocarditis, osteomyelitis, prosthetic joint infection, pneumonia warranting hospitalization, infection involving the central nervous system, and/or critical illness), an initial vancomycin loading dose (25 to 30 mg/kg, rounded to the nearest 250 mg increment) may be administered. Thereafter, intermittent maintenance dosing should be administered to achieve a target serum trough concentration of 15 to 20 mcg/mL [8,9]. (See 'Loading dose' below and 'Target concentrations' below.)

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Literature review current through: Dec 2017. | This topic last updated: Dec 04, 2017.
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