Antibiotic — Glycopeptide Pregnancy: Use with caution — crosses placenta; ototoxicity risk in fetus. Use only if no alternative.

Vancomycin (Burns — MRSA)

Brand names: Vancocin

Adult dose

Dose: 15–20 mg/kg IV every 8–12 hours (AUC-guided dosing); loading dose 25–30 mg/kg in severe infection

Route: IV infusion (over at least 60 min for each 500 mg)

Frequency: Every 8–12 hours (weight and renal function dependent)

Max: 3 g single loading dose; AUC/MIC target 400–600 mg·h/L

First-line systemic treatment for MRSA burns wound infection and burns sepsis. AUC-guided monitoring now preferred over trough-only monitoring (ASHP/IDSA 2020 guidelines). In burns: ARC increases clearance — may need more frequent dosing.

Paediatric dose

Dose: 15 mg/kg

Route: IV infusion

Frequency: Every 6 hours (neonates every 12h)

Max: 60 mg/kg/day

15 mg/kg IV every 6 hours in children >1 month. Neonates: 15 mg/kg every 12–24 hours depending on gestational age. Therapeutic drug monitoring essential.

Dose adjustments

Renal

Dose interval extended with renal impairment — AUC/MIC monitoring guides dosing. Avoid empiric dosing without TDM in renal failure.

Hepatic

No specific adjustment — renally cleared.

Paediatric weight-based calculator

Patient weight (kg)

15 mg/kg IV every 6 hours in children >1 month. Neonates: 15 mg/kg every 12–24 hours depending on gestational age. Therapeutic drug monitoring essential.

Clinical pearls

Red man syndrome: flushing, erythema, and hypotension during infusion — slow infusion rate, give antihistamine. NOT a true allergy — patient can continue vancomycin.
AUC-guided dosing (ASHP/IDSA 2020): superior to trough-only monitoring — reduces nephrotoxicity while maintaining efficacy. Target AUC/MIC 400–600.
Burns patients require higher and more frequent doses due to ARC and increased volume of distribution — standard 1 g BD is often subtherapeutic

Contraindications

Hypersensitivity to vancomycin

Side effects

Red man syndrome (histamine release — NOT allergy; slow infusion rate to prevent)
Nephrotoxicity (especially with aminoglycosides)
Ototoxicity (high levels)
Thrombophlebitis at infusion site
Neutropenia (prolonged)

Interactions

Aminoglycosides (additive nephrotoxicity and ototoxicity)
Loop diuretics (additive ototoxicity)
Neuromuscular blocking agents (potentiation)
NSAIDs (additive nephrotoxicity)

Monitoring

Vancomycin AUC (or trough 15–20 mg/L if AUC unavailable)
Renal function every 48–72h
Audiometry if prolonged use
White cell count

Reference: BNFc; BNF 90; ASHP/IDSA/SIDP Vancomycin Monitoring Guidelines 2020; BBA Burns Infection Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Teicoplanin (Burns — MRSA Alternative) · Antibiotic — Glycopeptide