Antibiotic (Glycopeptide) Pregnancy: C — use only if essential (crosses placenta, foetal ototoxicity risk)

Vancomycin

Brand names: Vancocin

Adult dose

Dose: AUC-guided dosing: target AUC/MIC 400–600. Loading dose 25–30mg/kg IV, then 15–20mg/kg every 8–12h

Route: IV (systemic) or Oral (C. difficile only)

Frequency: Every 8–12 hours (systemic). Oral C. difficile: 125mg QDS × 10 days

Traditional: 15mg/kg every 12h. AUC-guided dosing now preferred. Infuse over at least 60 min (red man syndrome risk with rapid infusion).

Dose: 15 mg/kg

Route: IV

Frequency: Every 6 hours

Max: 750mg per dose

Neonates: 10–15mg/kg every 12–24h (adjust based on gestational age). Children: 15mg/kg every 6h. TDM mandatory.

Paediatric weight-based calculator

Patient weight (kg)

Neonates: 10–15mg/kg every 12–24h (adjust based on gestational age). Children: 15mg/kg every 6h. TDM mandatory.

Red man syndrome (flushing, erythema, not allergy): slow infusion rate, premedicate with antihistamine
AUC/MIC-guided dosing now standard — reduces nephrotoxicity vs trough-only monitoring
Oral vancomycin NOT absorbed — used ONLY for Clostridium difficile (local gut action)
MRSA bacteraemia: vancomycin is gold standard. MIC creep is a concern — escalate to daptomycin if MIC ≥2 mg/L
Dose requires renal function (creatinine clearance) and ideal body weight calculations

AUC-guided TDM (preferred) or trough levels (target 15–20 mg/L for serious infections)
Renal function (every 48–72h)
FBC (neutropenia)
Hearing (prolonged courses)

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

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways