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Vancomycin Dosage

Applies to the following strength(s): 500 mg ; 500 mg/6 mL ; 125 mg ; 250 mg ; 250 mg/5 mL ; 1 g ; 10 g ; 5%-500 mg/100 mL ; 5 g ; 5%-1 g/200 mL ; 750 mg/150 mL-NaCl 0.9% ; 750 mg/150 mL-D5% ; 500 mg/100 mL-NaCl 0.9% ; 1 g/200 mL-NaCl 0.9% ; 750 mg ; 1.25 g/250 mL-NaCl 0.9% ; 1.5 g/250 mL-NaCl 0.9% ; 2 g/500 mL- NaCl 0.9% ; 2 g/250 mL-NaCl 0.9% ; 1.25 g/150 mL-NaCl 0.9% ; 1.25 g/250 mL-D5% ; 1.5 g/500 mL-D5% ; 1 g/250 mL-D5% ; 1 g/150 mL-NaCl 0.9% ; 500 mg/5 mL ; 1 g/250 mL-NaCl 0.9% ; 1.25 g/300 mL-NaCl 0.9% ; 1.5 g/300 mL-NaCl 0.9% ; 1.5 g/150 mL-NaCl 0.9% ; 1.75 g/250 mL-NaCl 0.9% ; 1.5 g/250 mL-D5% ; 1.5 g/500 mL-NaCl 0.9% ; 25 mg/mL ; 50 mg/mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Bacterial Infection

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Infectious Diseases Society of America (IDSA) Recommendations:
15 mg/kg IV every 12 hours

Comments:
-Treatment plus an aminoglycoside should be used for ampicillin-resistant, vancomycin-sensitive Enterococcus faecalis/Enterococcus faecium.

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA)/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, Corynebacterium jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by methicillin-susceptible S aureus (MSSA)/coagulase-negative staphylococci, ampicillin-susceptible E faecalis/E faecium

Usual Adult Dose for Endocarditis

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).
-Successful treatment of diphtheroid endocarditis has been reported.

Uses:
-Empirical treatment of staphylococcal endocarditis caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment (with an aminoglycoside) of endocarditis caused by enterococci, Streptococcus bovis, or Streptococcus viridans
-Empirical treatment (with an aminoglycoside and/or rifampin) of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis or diphtheroids

American Heart Association (AHA) and IDSA Recommendations:
15 to 20 mg/kg per day IV every 8 to 12 hours
-Maximum dose: 2 g/dose

Duration of treatment:
-Native Valve Endocarditis: At least 4 weeks
-Prosthetic Valve Endocarditis: At least 6 weeks

Comments:
-Patients may not require the addition of gentamicin or rifampin.
-Patients with native valve endocarditis caused by oxacillin-resistant staphylococci may require at least 6 weeks of treatment.

Uses:
-Treatment of endocarditis caused by highly penicillin-susceptible and relatively resistant to penicillin viridans group streptococci (VGS) and Streptococcus gallolyticus (bovis) in patients who cannot tolerate penicillin or ceftriaxone
-Treatment of endocarditis involving a prosthetic value/other prosthetic material caused by VGS and S gallolyticus (bovis)
-Alternative treatment of endocarditis caused by oxacillin-resistant staphylococci in patients with immediate-type hypersensitivity to beta-lactam antibiotics
-Treatment of penicillin-resistant endocarditis caused by enterococci in patients unable to tolerate beta-lactam antibiotics

Usual Adult Dose for Pseudomembranous Colitis

Clostridium difficile-associated diarrhea: 125 mg orally 4 times a day
-Duration of therapy: 10 days

Enterocolitis: 500 mg to 2 g orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Society of Healthcare Epidemiology of America (SHEA) and IDSA Recommendations:
Initial treatment of severe C difficile infection (CDI): 125 mg orally 4 times a day
-Duration of therapy: 10 to 14 days

Severe, complicated CDI: 500 mg orally 4 times a day AND 500 mg (in 100 mL normal saline) rectally every 6 hours with/without IV metronidazole

Comments:
-Rectal formulations should be administered as a retention enema.
-The first recurrence of CDI may be treated with the initial treatment regimen; a second recurrence of CDI may be treated with a tapered/pulsed regimen of this drug.

Uses:
-Initial treatment of patients with severe CDI
-Initial treatment of patients with complicated, severe CDI

Usual Adult Dose for Enterocolitis

Clostridium difficile-associated diarrhea: 125 mg orally 4 times a day
-Duration of therapy: 10 days

Enterocolitis: 500 mg to 2 g orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Society of Healthcare Epidemiology of America (SHEA) and IDSA Recommendations:
Initial treatment of severe C difficile infection (CDI): 125 mg orally 4 times a day
-Duration of therapy: 10 to 14 days

Severe, complicated CDI: 500 mg orally 4 times a day AND 500 mg (in 100 mL normal saline) rectally every 6 hours with/without IV metronidazole

Comments:
-Rectal formulations should be administered as a retention enema.
-The first recurrence of CDI may be treated with the initial treatment regimen; a second recurrence of CDI may be treated with a tapered/pulsed regimen of this drug.

Uses:
-Initial treatment of patients with severe CDI
-Initial treatment of patients with complicated, severe CDI

Usual Adult Dose for Pneumonia

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 8 to 12 hours
-Some experts recommend a loading dose of 25 to 30 mg/kg IV once (severe illness)

Uses:
-Empiric treatment of clinically suspected ventilator-associated pneumonia where MRSA coverage is appropriate
-Add-on empiric treatment of hospital-acquired pneumonia in patients not at high risk of mortality but with MRSA risk factors
-Add-on empiric treatment of hospital-acquired pneumonia in patients at high risk of mortality or with receipt of IV antibiotics within the previous 90 days

Usual Adult Dose for Nosocomial Pneumonia

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 8 to 12 hours
-Some experts recommend a loading dose of 25 to 30 mg/kg IV once (severe illness)

Uses:
-Empiric treatment of clinically suspected ventilator-associated pneumonia where MRSA coverage is appropriate
-Add-on empiric treatment of hospital-acquired pneumonia in patients not at high risk of mortality but with MRSA risk factors
-Add-on empiric treatment of hospital-acquired pneumonia in patients at high risk of mortality or with receipt of IV antibiotics within the previous 90 days

Usual Adult Dose for Osteomyelitis

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 to 20 mg/kg IV every 12 hours
-Duration of therapy: 4 to 6 weeks

Uses:
-First choice treatment for native vertebral osteomyelitis caused by oxacillin-resistant staphylococci, penicillin-resistant Enterococcus species
-Alternative treatment for native vertebral osteomyelitis caused by oxacillin-susceptible staphylococci
-Alternative treatment for native vertebral osteomyelitis caused by penicillin-susceptible Enterococcus species, Enterobacteriaceae, beta-hemolytic streptococci, or Propionibacterium acnes in patients allergic to penicillin

Usual Adult Dose for Sepsis

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Usual Adult Dose for Skin or Soft Tissue Infection

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of skin and skin structure infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 6 to 12 hours

Comment: Multidrug resistant organisms may require daily doses up to 60 mg/kg.

Uses:
-First-line treatment of treatment of skin and soft tissue infections (SSTIs) caused by MRSA in patients who require parenteral treatment
-Alternative treatment of SSTIs in patients with penicillin allergies
-Treatment of incisional surgical site infections of the lower trunk or extremity away from the axilla/perineum
-First-line treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Adult Dose for Bacteremia

IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours
-Duration of treatment: Up to 6 weeks, depending on the severity of infection

Use: Treatment of bacteremia

Usual Adult Dose for Meningitis

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks

Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.

Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus

Usual Adult Dose for CNS Infection

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks

Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.

Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus

Usual Adult Dose for Febrile Neutropenia

National Comprehensive Cancer Network (NCCN) Recommendations:
15 mg/kg IV every 12 hours

Comments:
-This drug should not be used as routine therapy for febrile neutropenia.
-Empiric therapy should be reassessed within 2 to 3 days of initiation. If gram-positive organisms are not found, discontinuation of treatment should be considered.
-Patients with resolved fever and neutrophil counts of at least 500 cells/mcL may discontinue therapy.

Use: Empiric prophylaxis in patients at high-risk for febrile neutropenia caused by serious gram-positive infections

Usual Adult Dose for Intraabdominal Infection

Surgical Infection Society (SIS) and IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours

Comment: Initial doses should be determined by total body weight.

Uses:
-Empiric treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by enterococci species or MRSA

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 15 to 30 mg/kg intraperitoneally every 5 to 7 days

Duration of therapy:
-Enterococcal peritonitis: 3 weeks
-Culture-negative peritonitis: 2 weeks

Use: Treatment of bacterial peritonitis

Usual Adult Dose for Peritonitis

Surgical Infection Society (SIS) and IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours

Comment: Initial doses should be determined by total body weight.

Uses:
-Empiric treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by enterococci species or MRSA

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 15 to 30 mg/kg intraperitoneally every 5 to 7 days

Duration of therapy:
-Enterococcal peritonitis: 3 weeks
-Culture-negative peritonitis: 2 weeks

Use: Treatment of bacterial peritonitis

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease

US CDC Recommendations:
1 g IV every 12 hours until delivery

Use: Prevention of early-onset group B streptococcal disease in patients with penicillin hypersensitivity and susceptibility is unknown/not possible or the isolates are resistant to erythromycin or clindamycin

Usual Adult Dose for Shunt Infection

IDSA, AAN, AANS, and NCS Recommendations:
Patients with slit ventricles: 5 mg via intraventricular route (plus gentamicin)
Patients with normal-sized ventricles: 10 mg via intraventricular route (plus gentamicin)
Patients with enlarged ventricles: 15 to 20 mg via intraventricular route (plus gentamicin)

Frequency of dosing:
-External drain output less than 50 mL/day: every 3 days
-External drain output 50 to 100 mL/day: every 2 days
-External drain output 100 to 150 mL/day: once a day
-External drain output 150 to 200 mL/day: increase the dose by 5 mg (plus gentamicin) and give once a day
-External drain output 200 to 250 mL/day: increase the dose by 10 mg (plus gentamicin) and give once a day

Use: Treatment of healthcare-associated ventriculitis and meningitis in patients who respond poorly to systemic antibiotics

Usual Adult Dose for Surgical Prophylaxis

American Society of Health-System Pharmacists (ASHP), IDSA, SHEA, and SIS Recommendations:
15 mg/kg IV once, within 120 minutes before surgery

Uses:
Alternative agent for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Cardiac procedures (e.g., coronary artery bypass, cardiac device insertion, ventricular assist devices)
-Neurosurgery (e.g., elective craniotomy and cerebrospinal fluid-shunting procedures, implantation of intrathecal pumps)
-Thoracic procedures (e.g., lobectomy, pneumonectomy, lung resection, thoracotomy, or video-assisted thorascopic surgery)
-Some orthopedic procedures (e.g., spinal procedures without instrumentation, hip fracture repair)
-Some urologic procedures (e.g., clean surgery without entry into urinary tract)
-Heart, lung, and heart-lung transplantation procedures (e.g., heart transplantation, lung and heart-lung transplantation)
-Clean-contaminated or clean plastic surgery procedures with risk factors

Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Gastroduodenal procedures (e.g., procedures involving entry in to the lumen of the gastrointestinal tract or procedures not entering the GI tract in high-risk patients)
-Some urologic procedures (e.g., clean surgery involving implanted prosthesis)

Usual Adult Dose for Head Injury

Armed Forces Infectious Disease Society (AFIDS), SIS, and IDSA Recommendations:
1 g IV every 12 hours plus ciprofloxacin
-Duration of therapy: 5 days OR until cerebrospinal fluid leak is closed, whichever is longer

Use: Antimicrobial prophylaxis for patients with penicillin allergies who have a penetrating brain or spinal cord injury

Usual Pediatric Dose for Bacteremia

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Osteomyelitis

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Bacterial Infection

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Sepsis

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Endocarditis

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).
-Successful treatment of diphtheroid endocarditis has been reported.

Use:
-Empirical treatment of staphylococcal endocarditis caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment (with an aminoglycoside) of endocarditis caused by enterococci, S bovis, or S viridans
-Empirical treatment (with an aminoglycoside and/or rifampin) of early-onset prosthetic valve endocarditis caused by S epidermidis or diphtheroids

AHA Recommendations: 40 to 60 mg/kg IV every 6 to 12 hours
-Maximum dose: 2 g/day

Duration of therapy:
-Empirical treatment: 4 to 6 weeks
-Staphylococci infection: 6 weeks

Comment: Gentamycin should be added to patients with enterococci infections.

Uses:
-Treatment of native valve and prosthetic valve infective endocarditis
-Empirical alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
-Empirical treatment of nosocomial endocarditis associated with vascular cannulae or early prosthetic valve endocarditis (1 year or less after surgery)
-Alternative treatment for streptococcal infections highly susceptible to penicillin G (e.g., groups A, B, C, G nonenterococcal, group D streptococci) and streptococci relatively resistant to penicillin (e.g., enterococci, less-susceptible S viridans)
-Alternative treatment for endocarditis caused by S aureus or coagulase-negative staphylococci susceptible or resistant to penicillin G and/or oxacillin in patients highly allergic to beta-lactam antibiotics

Usual Pediatric Dose for Pseudomembranous Colitis

Safety and efficacy have not been established in patients younger than 18 years of age.

The manufacturer recommends: 40 mg/kg orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Usual Pediatric Dose for Enterocolitis

Safety and efficacy have not been established in patients younger than 18 years of age.

The manufacturer recommends: 40 mg/kg orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Usual Pediatric Dose for Skin or Soft Tissue Infection

Less than 7 days:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 10 mg/kg IV every 12 hours

7 to 30 days:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 10 mg/kg IV every 8 hours

1 month and older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be administered over 1 hour.
-Premature infants may require a longer dosing interval.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use:
-Empirical treatment of skin and skin structure infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

The IDSA recommends:
10 to 15 mg/kg IV 3 to 4 times a day

Comments:
-Patients with necrotizing infections may require up to a 13 mg/kg dose given IV every 8 hours plus piperacillin.
-Patients with necrotizing infections caused by resistant Staphylococcus aureus may require 15 mg/kg given IV every 6 hours.

Use:
-First-line treatment of treatment of skin and soft tissue infections (SSTIs) caused by MRSA in patients who require parenteral treatment
-Alternative treatment of SSTIs in patients with penicillin allergies
-First-line treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Pediatric Dose for Pneumonia

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be administered over 1 hour.
-Premature infants may require a longer dosing interval.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:
10 to 20 mg/kg every 6 to 8 hours

Uses:
-Alternative treatment of community acquired pneumonia caused by S pneumoniae with penicillin MICs of less than or equal to 2 mcg/mL, S pneumoniae resistant to penicillin (MICs at least 4 mcg/mL), Group A Streptococcus, or MSSA
-Preferred treatment of community acquired pneumonia caused by MRSA (with/without susceptibility to clindamycin)

Usual Pediatric Dose for Intraabdominal Infection

SIS and IDSA Recommendations:
40 mg/kg IV per day, divided and given every 6 to 8 hours

Comment: This drug should be given as a 1 hour infusion.

Uses:
-Treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by Enterococci species or MRSA

ISPD Recommendations:
Prophylaxis: 25 mg/L intraperitoneally once

Treatment: 30 mg/kg intraperitoneally once, then 15 mg/kg intraperitoneally every 3 to 5 days

Uses:
-Prophylaxis against peritonitis in patients with known MRSA colonization at risk of touch contamination during instillation of peritoneal dialysis fluid after system disconnection OR disconnection during peritoneal dialysis
-Treatment of bacterial peritonitis

Usual Pediatric Dose for Peritonitis

SIS and IDSA Recommendations:
40 mg/kg IV per day, divided and given every 6 to 8 hours

Comment: This drug should be given as a 1 hour infusion.

Uses:
-Treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by Enterococci species or MRSA

ISPD Recommendations:
Prophylaxis: 25 mg/L intraperitoneally once

Treatment: 30 mg/kg intraperitoneally once, then 15 mg/kg intraperitoneally every 3 to 5 days

Uses:
-Prophylaxis against peritonitis in patients with known MRSA colonization at risk of touch contamination during instillation of peritoneal dialysis fluid after system disconnection OR disconnection during peritoneal dialysis
-Treatment of bacterial peritonitis

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SHEA, and SIS Recommendations:
15 mg/kg IV once, within 120 minutes before surgery

Uses:
Alternative agent for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Cardiac procedures (e.g., coronary artery bypass, cardiac device insertion, ventricular assist devices)
-Neurosurgery (e.g., elective craniotomy and cerebrospinal fluid-shunting procedures, implantation of intrathecal pumps)
-Thoracic procedures (e.g., lobectomy, pneumonectomy, lung resection, thoracotomy, or video-assisted thorascopic surgery)
-Some orthopedic procedures (e.g., spinal procedures without instrumentation, hip fracture repair)
-Some urologic procedures (e.g., clean surgery without entry into urinary tract)
-Heart, lung, and heart-lung transplantation procedures (e.g., heart transplantation, lung and heart-lung transplantation)
-Clean-contaminated or clean plastic surgery procedures with risk factors

Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Gastroduodenal procedures (e.g., procedures involving entry in to the lumen of the gastrointestinal tract or procedures not entering the GI tract in high-risk patients)
-Some urologic procedures (e.g., clean surgery involving implanted prosthesis)

Usual Pediatric Dose for Meningitis

IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours
-Duration of therapy: 2 weeks

Use: Treatment of patients with healthcare-associated ventriculitis and meningitis

Usual Pediatric Dose for CNS Infection

IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours
-Duration of therapy: 2 weeks

Use: Treatment of patients with healthcare-associated ventriculitis and meningitis

Usual Pediatric Dose for Shunt Infection

IDSA, AAN, AANS, and NCS Recommendations:
Patients with slit ventricles: 5 mg via intraventricular route (plus gentamicin)

Patients with normal-sized ventricles: 10 mg via intraventricular route (plus gentamicin)

Patients with enlarged ventricles: 15 to 20 mg via intraventricular route (plus gentamicin)

Frequency of dosing:
-External drain output less than 50 mL/day: every 3 days
-External drain output 50 to 100 mL/day: every 2 days
-External drain output 100 to 150 mL/day: once a day
-External drain output 150 to 200 mL/day: increase the dose by 5 mg (plus gentamicin) and give once a day
-External drain output 200 to 250 mL/day: increase the dose by 10 mg (plus gentamicin) and give once a day

Comments:
-Some experts recommend decreasing the dose by 60% when treating infants to account for lower cerebrospinal fluid volume (compared to adults).

Use: Treatment of healthcare-associated ventriculitis and meningitis in patients who respond poorly to systemic antibiotics

Usual Pediatric Dose for Head Injury

AFIDS, SIS, and IDSA Recommendations:
60 mg/kg, divided and given every 6 to 8 hours
-Duration of therapy: 5 days OR until cerebrospinal fluid leak is closed, whichever is longer

Use: Antimicrobial prophylaxis for patients with penicillin allergies who have a penetrating brain or spinal cord injury

Renal Dose Adjustments

Mild to moderate renal dysfunction:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 1.9 mg/kg IV every 24 hours

Severe renal dysfunction:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 1.9 mg/kg IV every 24 hours OR 250 to 1000 mg IV once every several days

Patients with anuria:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 1000 mg IV once every 7 to 10 days

Liver Dose Adjustments

Data not available

Dose Adjustments

Elderly patients: Dosing may be determined based on renal function.

Therapeutic drug monitoring/range: 10 to 20 mcg/mL (trough)

Precautions

Safety and efficacy of oral capsule formulations have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

IDSA Recommendations:
Hemodialysis:
-Empirical dosing for bacterial infections: 20 mg/kg loading dose IV (infused during the last hour of the dialysis session), then 500 mg IV during the last 30 minutes of each subsequent dialysis session

ISPD Recommendations:
Peritoneal Dialysis:
Pediatric patients:
-High-risk gastrointestinal procedures: 10 mg/kg IV once (Maximum dose: 1 g)

Other Comments

Administration advice:
-This drug should be infused over at least 1 hour.
-Lyophilized powder for injection may be mixed and given orally or via nasogastric tube.

Storage requirements:
-Injection solutions: The manufacturer produce information should be consulted.
-Lyophilized powder for injection: Vials may be stored in a refrigerator for up to 48 hours once reconstituted.

Reconstitution/preparation techniques:
-Lyophilized powder for injection: Flavoring syrups may be added to the formulation to improve taste.

IV compatibility: The manufacturer product information should be consulted.

General:
-Oral capsule formulations are not systemically absorbed, and should be reserved for the treatment of staphylococcal enterocolitis and C difficile-associated diarrhea.
-Parenteral formulations should not be used intravenously to treat staphylococcal enterocolitis and C difficile-associated diarrhea.
-Limitations of use: Safety and efficacy of intrathecal (intralumbar/intraventricular) and peritoneal administration have not been established.

Monitoring:
-Hearing tests, especially in patients given high doses and/or those over 60 to 65 years of age
-Renal function, especially in patients with renal dysfunction, those given high doses and/or in patients with high troughs
-Localized infusion reactions
-Periodic leukocyte counts, especially in patients receiving concomitant neutropenia-inducing drugs and/or those undergoing prolonged treatment
-Periodic urinalysis
-Periodic liver function tests
-Trough blood levels

Patient advice:
-Patients should be advised to avoid missing doses and to complete the entire course of therapy.
-Patients should be instructed to report signs/symptoms of C difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.

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