Adults: The usual adult dose is the equivalent of 500 mg of Vancomycin every 6 hours or 1 g every 12 hours, diluted with sodium chloride or 5% glucose solution. Therapeutic response is generally verified in 48-72 hours. The treatment duration should be adjusted with respect to the disease and other clinical infection circumstances. In staphylococcal endocarditis the recommended duration of the treatment is at least 3 weeks.
Children: Children may be given 44 mg per kg body-weight daily in daily in divided dose (every 6 hours). The quantity of diluted solution must be for a 24 hours administration.
Neonates and nurslings: Neonates and nurslings may be given an initial dose of 15 mg per kg followed, in neonates, by 10 mg per kg every 12 hours in the first week of life, and every 8 hours up to the age of one month. Each infusion should be used over 60 minutes. In these patients serum-vancomycin concentrations should be monitored.
With impaired renal function: In patients with impaired renal function, dosage regimen of vancomycin must be modified in response to degree of renal impairment, severity of infection, susceptibility of causative organism and serum concentrations of the drug. A suggested starting dose in patients with impaired renal function is 15 mg/kg with subsequent doses based mainly on renal function and serum concentrations of the drug.
Accumulation of the drug may occur with prolonged therapy and regular monitoring of serum levels should be carried out. The following guide is provided. This data is not valid for functionally anephric patients on dialysis. (See table.)
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In anephric patients, a loading dose of 15 mg/kg body weight should be given with subsequent dosage of 1.9 mg/kg/24 hrs. Since individual maintenance doses of 250 mg-1 g are convenient in patients with marked renal impairment, a dose may be given every several days rather than on a daily basis. In anuria a dose of 1 g every 7-10 days has been recommended.
In patients on haemodialysis, the drug is not significantly removed by haemodialysis. A dose of 1 g of vancomycin every seven days produces effective blood levels. Serum levels should be monitored to avoid drug accumulation and resultant toxicity. The serum half-life ranges from 120 to 216 hours.
In patients undergoing peritoneal dialysis, the half-life of vancomycin has been reported at around 18 hours. To prevent undue lowering of serum levels during peritoneal dialysis, an additional amount of vancomycin could be added to the dialysate in a concentration of 25 microgram per ml.
Reconstitute each 500 mg vial with 10 ml of Water for Injections and dilute with infusion fluid (either Glucose 5% or Sodium Chloride 0.9%) to a concentration of up to 5 mg/ml. The concentration can be increased to 10 mg/ml in fluid restriction but increased risk of infusion-related effects. The injection is to be injected intermittently over at least 60 minutes and at a rate not exceeding 10 mg/minute for doses over 500 mg. Use continuous infusion only if intermittent not feasible.
Mode of Administration: Vancomycin is administered by slow intravenous infusion.