Dosage regimens for intravenous drip introduction
Intravenously (intravenously) is drip. The drug can not be administered intramuscularly or intravenously bolus (struino)!
Adults and children over 12 years of age, with normal renal function: 0.5 g every 6 hours, or 1 g every 12 hours. Each dose is recommended to enter at a speed of not more than 10 mg / min, the duration of infusion is not less than 60 minutes. The daily dose is 2 g. Age, the presence of obesity may require a change in the usual dose based on the determination of the concentration of vancomycin in the serum.
Children from 1 month to 12 years: at 10 mg / kg every 6 hours. Each dose is administered for at least 60 minutes. The recommended daily dose is 40 mg / kg.
Newborns: the initial dose of 15 mg / kg, then in a maintenance dose of 10 mg / kg every 12 hours during the first week of life; beginning from the second week of life a maintenance dose of 10 mg / kg is administered every 8 hours until age 1 month. Each dose should be administered at least 60 minutes, constant monitoring of the concentration of vancomycin in the serum is required.
The concentration of the prepared solution of vancomycin - not more than 2.5-5 mg / ml. The maximum daily dose for a child should not exceed the daily dose for an adult - 2 g.
Patients with impaired renal function Individual dose selection is necessary, taking into account the level of serum creatinine. Correction can be carried out by increasing the intervals between administrations, or by reducing the single dose of the drug.
Correction by increasing the intervals between administrations
| Creatinine clearance (CK) (ml / min) | Vancomycin Dose | Interval between doses |
| >80 | 0.5 g or 1 g | 12h |
| 80-50 | 1 g | 24 h |
| 50-10 | 1 g | 3-7 days |
| <10 (anuria) | 1 g | 7-14 days |
In elderly patients clearance of vancomycin below, the volume of distribution is greater, the dose is selected according to the concentration of vancomycin in the serum.
Have premature babies and elderly patients as a result of reduced renal function, a significant dose reduction may be required. The concentration of vancomycin in the blood plasma should be monitored regularly.
Correction of a single dose depending on the creatinine clearance
| Creatinine clearance (ml / min) | Dose of vancomycin (mg / day) | Creatinine clearance (ml / min) | Dose of vancomycin (mg / day) |
| 100 | 1545 | 50 | 770 |
| 90 | 1390 | 40 | 620 |
| 80 | 1235 | 30 | 465 |
| 70 | 1080 | 20 | 310 |
| 60 | 925 | 10 | 155 |
When anuria this table can not be used to determine the dose of the drug. For anuria, the initial dose is 15 mg / kg to rapidly create therapeutic concentrations of vancomycin in the serum, for a stable drug concentration, a maintenance dose of 1.9 mg / kg / day.
Correction by increasing the intervals between administrations
Patients with severe renal insufficiency are advised to administer maintenance doses of 250-1000 mg once every few days: with KK 10-50 ml / min - 1 g every 3-7 days, with CK <10 ml / min - 1 g every 7-14 days. When anuria a dose of 1 g is recommended every 7-10 days.
According to the known concentration of creatinine in the serum, calculate the clearance of creatinine according to the formula:
For men: body weight, kg x (140 - age, years) / 72 x serum creatinine concentration, mg / 100 ml
For women: the result is multiplied by 0.85.
Patients on hemodialysis: the initial dose is 20-25 mg / kg, when using membranes with high permeability. Supportive doses are administered based on the residual drug concentration in the blood plasma and adjusted to maintain a residual drug concentration of 15-20 μg / ml.
Vancomycin is effectively removed by hemodialysis using high-permeability membranes (such as polysulfone), but is poorly eliminated when using membranes with normal permeability.
Patients with hepatic insufficiency no dose adjustment is required.
Preparation and administration of a solution for infusion
Solution for infusion is prepared in two stages.
First step: the drug is dissolved in water for injection: 0.5 g in 10 ml, 1 g in 20 ml (the concentration of the solution is 50 mg / ml). The solution thus prepared can be stored at room temperature (not higher than 25 ° C) for 24 hours or in a refrigerator (2 to 8 ° C) for 96 hours.
Second phase: the solutions of vancomycin obtained before the introduction in the first stage are to be further diluted to a concentration of no more than 5 mg / ml before they are injected into a compatible solution for infusions: 0.5 g in 100 ml and 1 g in 200 ml with 0.9% solution of sodium chloride, 5% dextrose solution or Ringer's solution.
The required dose of vancomycin diluted in this way should be administered by fractional infusion for at least 60 minutes.
Infusion solutions of the drug based on a 0.9% solution of sodium chloride or 5% dextrose solution can be stored in the refrigerator (2 to 8 ° C) for 14 days without significant loss of activity. Solutions prepared on the basis of Ringer's solution can be stored in the refrigerator for 4 days (96 hours).
Before administration, the prepared infusion solution should be visually inspected for mechanical impurities and discoloration.
Dosage regimens for oral administration
Vancomycin can be used orally to treat pseudomembranous colitis caused by Clostridium difficile due to the use of antibiotics, as well as for the treatment of staphylococcal enterocolitis. Intravenous administration of vancomycin has no advantage in the treatment of these diseases.
The drug should be used in the following doses: adults 0.5-2 g 3-4 times / day, children 0.04 g / kg 3-4 times / day. The total daily dose should not exceed 2 g. The appropriate dose is prepared in 30 ml of water and given to the patient to drink or injected through the probe. To improve the taste of the solution, ordinary food syrups can be added to it. Duration of treatment is from 7 to 10 days. Vancomycin It is not effective at ingestion in case of other localizations of infections.