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Glycopeptide antibiotic Pregnancy: Use only if clearly indicated. Potential ototoxicity/nephrotoxicity in fetus.

Vancomycin

Brand names: Vancocin

Adult dose

Dose: 25–30 mg/kg loading dose IV, then AUC-guided dosing (target AUC/MIC 400–600)
Route: IV infusion over at least 60 minutes (to prevent Red Man Syndrome)
Frequency: Typically every 6–12 hours, guided by levels
Max: 3 g loading dose; daily dose up to 4.5 g (level-guided)
MRSA treatment: loading 25–30 mg/kg IV, then TDM-guided maintenance (ASHP/IDSA 2020 AUC-based dosing). Oral vancomycin (125–500 mg QDS) for C. difficile — not absorbed systemically. Infuse over minimum 1 hour (Red Man Syndrome prevention).

Paediatric dose

Dose: 15 mg/kg
Route: IV
Frequency: Every 6 hours
Max: 60 mg/kg/day
Concentration: 5 mg/ml
Neonates: 15 mg/kg every 12–24h (by gestational age and weight). Infants/children: 15 mg/kg every 6 hours. Target trough: 10–15 mg/L (or AUC/MIC 400–600). Infuse over 60 minutes.

Dose adjustments

Renal

Significantly reduce dose and/or frequency. Use AUC-guided or trough-guided dosing. Haemodialysis patients: 15 mg/kg post-dialysis.

Hepatic

No dose adjustment required for hepatic disease alone.

Paediatric weight-based calculator

Neonates: 15 mg/kg every 12–24h (by gestational age and weight). Infants/children: 15 mg/kg every 6 hours. Target trough: 10–15 mg/L (or AUC/MIC 400–600). Infuse over 60 minutes.

Clinical pearls

  • Red Man Syndrome is rate-dependent (not allergy) — slow infusion to 1–2 hours
  • AUC-guided dosing (ASHP/IDSA 2020) preferred over trough alone — reduces nephrotoxicity
  • Oral vancomycin not absorbed — used only for C. difficile GI tract treatment
  • MRSA bloodstream infection: vancomycin plus source control (drain abscess, remove lines)
  • Daily dose adjustment based on AUC/MIC targeting 400–600 mg•h/L

Contraindications

  • Hypersensitivity to vancomycin

Side effects

  • Red Man Syndrome (flushing, pruritus, hypotension — infusion rate related)
  • Nephrotoxicity (especially with aminoglycosides)
  • Ototoxicity (tinnitus, hearing loss)
  • Thrombophlebitis at IV site
  • Neutropenia (prolonged use)

Interactions

  • Aminoglycosides — synergistic but significantly increased nephrotoxicity and ototoxicity
  • Loop diuretics (furosemide) — increased ototoxicity risk
  • NSAIDs — increased nephrotoxicity
  • Neuromuscular blocking agents — may enhance block

Monitoring

  • Vancomycin AUC/trough levels
  • Renal function (U&E, creatinine) daily
  • Audiometry (prolonged use)
  • FBC

Reference: BNFc; BNF; ASHP/IDSA/SIDP 2020 Vancomycin Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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