For IV infusion and oral administration. Do not administer intramuscularly (IM).
For intravenous infusion
The rate of administration is not more than 10 mg / min. Duration of administration for at least 60 minutes. The recommended concentration is not more than 5 mg / ml. Patients who are shown to restrict fluid intake can use a concentration of up to 10 mg / ml and a rate of administration not exceeding 10 mg / min. However, if such concentrations are used, the incidence of side effects associated with infusion increases.
Adults and children over 12 years (with normal renal function)
For 500 mg every 6 hours or 1 g every 12 hours. The maximum daily dose is 2 g.
Children over the age of 1 month and up to 12 years of age
At 10 mg / kg IV every 6 hours. Each dose should be administered for at least 60 minutes. The maximum daily dose for a child should not be higher than the daily dose for an adult (2 g).
Children under the age of 1 month
The initial dose is 15 mg / kg, followed by 10 mg / kg every 12 hours during the first week of life and every 8 hours between the ages of 2 weeks and one month. Each dose should be administered for at least 60 minutes. In such patients, it is advisable to carefully monitor the concentration of vancomycin in the blood plasma.
Recommendations for dosing vancomycin in neonates are given in Table 1.
Table №1. Recommendations for dosing of vancomycin in newborns
| VNSBa (weeks) | Chronological age (days) | Serum creatinine (mg / dL)b | Dose (mg / kg) |
| less than 30 | not more than 7 | -c | 15 every 24 hours |
|
| more than 7 | no more than 1,2 | 10 every 12 hours |
| 30-36 | not more than 14 | -c | 10 every 12 hours |
|
| more than 14 | not more than 0,6 | 10 every 8 hours |
|
|
| 0,7-1,2 | 10 every 12 hours |
| more than 36 | not more than 7 | -c | 10 every 12 hours |
|
| more than 7 | not more than 0,6 | 10 every 8 hours |
|
|
| 0,7-1,2 | 10 every 12 hours |
a - VMNB = age from the moment of the beginning of pregnancy (the age of intrauterine development plus the chronological age).
b - if the serum creatinine concentration is more than 1.2 mg / dl, an initial dose of 15 mg / kg every 24 hours is used.
from - serum creatinine concentration is not used to determine the dose for these patients, since this indicator is not informative in this case or due to lack of information.
In such patients, it is advisable to carefully monitor the concentration of vancomycin in the blood serum.
Patients with impaired renal function and elderly patients
Patients with impaired renal function need to individually select the dose in accordance with the clearance of creatinine (CC). The dose is calculated using Table No. 2.
In elderly patients vancomycin has a lower ground clearance and a larger volume of distribution. In this group, the choice of a dose is expedient to be carried out on the basis of the concentrations of vancomycin in the blood serum.
In premature infants and in 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. In the table below, doses of vancomycin are given depending on the QC.
Table number 2. Doses of vancomycin for patients with impaired renal function
| CK, ml / min | Dose of vancomycin, mg / 24 h |
| 100 | 1545 |
| 90 | 1390 |
| 80 | 1235 |
| 70 | 1080 |
| 60 | 925 |
| 50 | 770 |
| 40 | 620 |
| 30 | 465 |
| 20 | 310 |
| 10 | 155 |
Patients with anuria treatment is started with a dose of 15 mg / kg body weight to quickly create therapeutic concentrations of vancomycin in the blood plasma. The dose required to maintain a stable concentration of vancomycin is 1.9 mg / kg / 24 hours. The recommended dose is 1 g for 7-10 days.
Patients with severe renal insufficiency it is advisable to administer maintenance doses of 250-1000 mg once every few days.
The QC can be calculated from the formulas:
KK for men = body weight (kg) * (140 - age (full years)) / 72 * serum creatinine concentration;
QC for women = QC men * 0.85.
Preparation of solution for intravenous administration
10 ml are added to the contents of the Vancomycin-Teva 500 mg bottle, and the contents of the Vancomycin-Teva Vial of 1000 mg are 20 ml of distilled water for injection to obtain a reconstituted solution of vancomycin at a concentration of 50 mg / ml. The reconstituted solution must be clear and free from foreign particles.
The reconstituted solution can be stored at a temperature of not more than + 25 ° C for 24 hours or at a temperature of +2 + 8 ° C for 96 hours.
Before infusion, further dilution of the aqueous solution is required.
A reconstituted solution of Vancomycin-Teva 10 ml (or 20 ml) is added to 100 ml (or 200 ml) of 5% dextrose solution or 0.9% sodium chloride solution to obtain a solution of vancomycin for infusions at a concentration of 5 mg / ml. The prepared solution should be clear and free from foreign particles.
The prepared solution of the drug Vancomycin-Teva for intravenous infusion can be stored at a temperature of no more than +25 ° C for 24 hours or at a temperature of + 2- + 8 ° C for 96 hours. From a microbiological point of view, drug solutions must be applied immediately after dilution if recovery and dilution occurred in controlled and standard aseptic conditions. If solutions are not used immediately after preparation, the terms and conditions of storage are the responsibility of the user.
Before the infusion, the prepared intravenous solution should be visually inspected for mechanical impurities and discoloration. Solution for infusion is used after warming up to body temperature.
For oral administration
Vancomycin can be used orally to treat pseudomembranous colitis associated with Clostridium difficile, arisen after antibiotic therapy, and staphylococcal enterocolitis. In / in the introduction of vancomycin has no advantage in the treatment of pseudomembranous colitis and staphylococcal enterocolitis. Vancomycin Ineffective if ingested in the case of other infections.
Adults
2000 mg divided into 3-4 doses per day. The maximum daily dose of 2000 mg / day. The duration of treatment is 7-10 days.
Children
40 mg / kg divided into 3-4 doses per day. The maximum daily dose of 2000 mg / day. The duration of treatment is 7-10 days.
Preparation of solution for ingestion
The contents of the vial (500 mg of vancomycin) are diluted with 30 ml of water. The prepared solution can be taken or injected orally through a nasogastric tube. To improve the taste of the solution, ordinary food syrups can be added to it.