Vancomycin

Recommendation	Use actual BW
Comments	Current guidelines: loading dose 20-25 mg/kg (max 3 gm), maintenance dose 15-20 mg/kg (max 2 gm) q8-12h. Daily doses >4.5 gm should rarely be required. Early and frequent AUC₂₄ monitoring is recommended (Am J Health Syst Pharm 2020;77:835). Decreased AKI risk with AUC₂₄ monitoring (compared to trough monitoring) in patients with BMI >30 (Antimicrob Agents Chemother 2022;66:e0088621). Controversy continues: recent review suggests loading dose based on actual BW and maintenance dose based on adjusted BW (Expert Opin Drug Metab Toxicol 2022;18:323).

Recommendation

Use actual BW

Comments

Current guidelines: loading dose 20-25 mg/kg (max 3 gm), maintenance dose 15-20 mg/kg (max 2 gm) q8-12h. Daily doses >4.5 gm should rarely be required. Early and frequent AUC₂₄ monitoring is recommended (Am J Health Syst Pharm 2020;77:835). Decreased AKI risk with AUC₂₄ monitoring (compared to trough monitoring) in patients with BMI >30 (Antimicrob Agents Chemother 2022;66:e0088621). Controversy continues: recent review suggests loading dose based on actual BW and maintenance dose based on adjusted BW (Expert Opin Drug Metab Toxicol 2022;18:323).

NTTGUIDE

Vancomycin