See alsoAntimicrobial guidelines Show Key points
Dose
Continuous infusion Infants 0 to 90 days of age
* >60 to the upper limit of normal (ULN) for serum creatinine. For children with moderate to severe renal impairment, seek specialist advice for dosing Infants and children >90 days of age Commence at the dose equivalent to the total daily dose administered in the previous 24 hour period
Initiating vancomycin treatment with a continuous infusion: Therapeutic drug monitoring
Dose adjustment Adjusted dose (mg/day) = last maintenance dose (mg/day) x (target level/last vancomycin level) Eg if a 3 kg infant is prescribed 50 mg/kg/day and has a vancomycin level of 13 mg/L, the adjusted dose = 150 mg x (20/13) = 230 mg/day Intermittent dosingInfants 0-90 days old
* >60 to the upper limit of normal (ULN) for serum creatinine. For children with moderate to severe renal impairment, seek specialist advice for dosing Infants and children >90 days of age Usual starting dose: 15 mg/kg/dose (maximum 750 mg) every 6 hours
Therapeutic drug monitoring
Vancomycin levels should be repeated until there are two consecutive levels within target range. After this, vancomycin levels can be repeated every 3 days or whenever there is a significant change in bodyweight, serum creatinine or if the dose has been adjusted. Dose adjustment
AdministrationDilute to 5 mg/mL or weaker and infuse over at least 60 minutes (maximum rate 10 mg/minute) Concentrations up to 10 mg/mL may be administered via a central line if necessary, the risk of infusion reactions is increased with higher concentrations (see Adverse Effects section below). Adverse EffectsVancomycin is potentially nephrotoxic and ototoxic especially when used in combination with other nephrotoxic or ototoxic agents (eg aminoglycosides) and in renal impairment. Rapid infusion may cause vancomycin infusion reaction (previously referred to as red man syndrome):
These features develop quickly and usually subside within an hour but may persist for several hours in some cases If symptoms of vancomycin infusion reaction occur:
Consider consultation with local paediatric team when
Consider transfer whenChild requiring care beyond the level of comfort of the local hospital For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650 Last Updated November, 2019 |