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Vancomycin Dosage

Medically reviewed by Drugs.com. Last updated on Aug 4, 2023.

Applies to the following strengths: 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; 1.25 g; 1.5 g; 750 mg; 1.25 g/250 mL-D5%; 1.5 g/300 mL-D5%; 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%; 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%; 1.5 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%; 25 mg/mL; 50 mg/mL; 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%; 500 mg/100 mL; 1 g/200 mL; 1.5 g/300 mL; 2 g/400 mL; 750 mg/150 mL; 1.25 g/250 mL; 1.75 g/350 mL; 1.75 g/500 mL-NaCl 0.9%; 750 mg/250 mL-NaCl 0.9%; 100 mg/mL

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Bacterial Infection

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

Comments:


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:

Uses:

American Society of Health-System Pharmacists (ASHP), IDSA, Surgical Infection Society (SIS), and Society for Infectious Diseases Pharmacists (SIDP) Recommendations:
Serious MRSA Infections:
Intermittent infusion: 15 to 20 mg/kg IV per day, given in divided doses every 6 to 8 hours

Critically Ill Patients:
Intermittent infusion:

Continuous infusion:

Comments:

Use: Treatment of patients with known/suspected serious MRSA infections

Usual Adult Dose for Endocarditis

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

Comments:


Uses:

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

Duration of treatment:

Comments:

Uses:

Usual Adult Dose for Pseudomembranous Colitis

Clostridioides (Clostridium) difficile-associated diarrhea: 125 mg orally 4 times a day


Enterocolitis: 500 mg to 2 g orally per day, given in divided doses 3 to 4 times a day

Comment: Formulations administered parenterally will not treat colitis.

Uses:

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

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:

Uses:

Usual Adult Dose for Enterocolitis

Clostridioides (Clostridium) difficile-associated diarrhea: 125 mg orally 4 times a day


Enterocolitis: 500 mg to 2 g orally per day, given in divided doses 3 to 4 times a day

Comment: Formulations administered parenterally will not treat colitis.

Uses:

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

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:

Uses:

Usual Adult Dose for Pneumonia

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

Comments:


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

Uses:

Usual Adult Dose for Nosocomial Pneumonia

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

Comments:


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

Uses:

Usual Adult Dose for Osteomyelitis

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

Comments:


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

Uses:

Usual Adult Dose for Sepsis

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

Comments:


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:


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:

Usual Adult Dose for Bacteremia

IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours


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


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

Uses:

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


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

Uses:

Usual Adult Dose for Febrile Neutropenia

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

Comments:


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

Usual Adult Dose for Intraabdominal Infection

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:


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

Duration of therapy:

Use: Treatment of bacterial peritonitis

Usual Adult Dose for Peritonitis

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:


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

Duration of therapy:

Use: Treatment of bacterial peritonitis

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease

US Centers for Disease Control and Prevention (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:


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

Usual Adult 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:


Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:

Usual Adult Dose for Head Injury

Armed Forces Infectious Disease Society (AFIDS), SIS, and IDSA Recommendations:
1 g IV every 12 hours plus ciprofloxacin


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

Usual Pediatric Dose for Bacteremia

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Uses:

American Academy of Pediatrics (AAP) Recommendations:
Empiric treatment:
Life-threatening infections: 15 mg/kg IV every 6 hours PLUS nafcillin OR oxacillin
Non-life-threatening infections without signs of sepsis: 15 mg/kg IV every 6 to 8 hours

Bacterial Infection:
Neonates (Up to 28 postnatal days):
Loading dose: 20 mg/kg IV ONCE
Gestational age 28 weeks or less:

Gestational age greater than 28 weeks:

Pediatric patients 28 days and older: 45 to 60 mg/kg IV per day, given in 3 to 4 divided doses

Invasive MRSA infections:

Nonmeningeal pneumococcal infections:

Comment: Serum concentrations should be used to guide ongoing treatment.

Uses:

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours

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

Uses:

ASHP, IDSA, SIS, and SIDP Recommendations:
Serious MRSA Infections:
Neonates and children up to 3 months:

3 months and older:

Comments:

Usual Pediatric Dose for Osteomyelitis

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Uses:

American Academy of Pediatrics (AAP) Recommendations:
Empiric treatment:
Life-threatening infections: 15 mg/kg IV every 6 hours PLUS nafcillin OR oxacillin
Non-life-threatening infections without signs of sepsis: 15 mg/kg IV every 6 to 8 hours

Bacterial Infection:
Neonates (Up to 28 postnatal days):
Loading dose: 20 mg/kg IV ONCE
Gestational age 28 weeks or less:

Gestational age greater than 28 weeks:

Pediatric patients 28 days and older: 45 to 60 mg/kg IV per day, given in 3 to 4 divided doses

Invasive MRSA infections:

Nonmeningeal pneumococcal infections:

Comment: Serum concentrations should be used to guide ongoing treatment.

Uses:

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours

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

Uses:

ASHP, IDSA, SIS, and SIDP Recommendations:
Serious MRSA Infections:
Neonates and children up to 3 months:

3 months and older:

Comments:

Usual Pediatric Dose for Bacterial Infection

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Uses:

American Academy of Pediatrics (AAP) Recommendations:
Empiric treatment:
Life-threatening infections: 15 mg/kg IV every 6 hours PLUS nafcillin OR oxacillin
Non-life-threatening infections without signs of sepsis: 15 mg/kg IV every 6 to 8 hours

Bacterial Infection:
Neonates (Up to 28 postnatal days):
Loading dose: 20 mg/kg IV ONCE
Gestational age 28 weeks or less:

Gestational age greater than 28 weeks:

Pediatric patients 28 days and older: 45 to 60 mg/kg IV per day, given in 3 to 4 divided doses

Invasive MRSA infections:

Nonmeningeal pneumococcal infections:

Comment: Serum concentrations should be used to guide ongoing treatment.

Uses:

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours

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

Uses:

ASHP, IDSA, SIS, and SIDP Recommendations:
Serious MRSA Infections:
Neonates and children up to 3 months:

3 months and older:

Comments:

Usual Pediatric Dose for Sepsis

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Uses:

American Academy of Pediatrics (AAP) Recommendations:
Empiric treatment:
Life-threatening infections: 15 mg/kg IV every 6 hours PLUS nafcillin OR oxacillin
Non-life-threatening infections without signs of sepsis: 15 mg/kg IV every 6 to 8 hours

Bacterial Infection:
Neonates (Up to 28 postnatal days):
Loading dose: 20 mg/kg IV ONCE
Gestational age 28 weeks or less:

Gestational age greater than 28 weeks:

Pediatric patients 28 days and older: 45 to 60 mg/kg IV per day, given in 3 to 4 divided doses

Invasive MRSA infections:

Nonmeningeal pneumococcal infections:

Comment: Serum concentrations should be used to guide ongoing treatment.

Uses:

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours

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

Uses:

ASHP, IDSA, SIS, and SIDP Recommendations:
Serious MRSA Infections:
Neonates and children up to 3 months:

3 months and older:

Comments:

Usual Pediatric Dose for Endocarditis

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Use:

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours
Invasive MRSA infections: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:

AHA Recommendations:
40 to 60 mg/kg IV per day, given in divided doses every 6 to 12 hours

Duration of therapy:

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

Uses:

Usual Pediatric Dose for Pseudomembranous Colitis

Oral solution:
Less than 18 years: 40 mg/kg orally in 3 to 4 divided doses


Comments:

Uses:

AAP Recommendations:
Children:
FIRST OCCURRENCE:
Mild-moderate infection:
Failure to respond within 5 to 7 days, pregnant/breastfeeding, OR metronidazole-intolerant patients: 10 mg/kg orally every 6 hours

Patients for whom oral therapy cannot reach colon: 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS oral metronidazole OR oral vancomycin

Severe infection: 10 mg/kg orally every 6 hours

Severe and complicated infection:
No abdominal distention: 10 mg/kg orally every 6 hours PLUS metronidazole

Complicated with ileus or toxic colitis and/or significant abdominal distention: 10 mg/kg orally every 6 hours PLUS 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS metronidazole

FIRST RECURRENCE:
Mild-moderate infection:
Failure to respond within 5 to 7 days, pregnant/breastfeeding, OR metronidazole-intolerant patients: 10 mg/kg orally every 6 hours

Patients for whom oral therapy cannot reach colon: 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS oral metronidazole OR oral vancomycin

Severe infection: 10 mg/kg orally every 6 hours

SECOND RECURRENCE:
Tapered regimen:

Alternative tapered regimen: 10 mg/kg orally 4 times a day for 14 days, then 10 mg/kg orally 2 times a day for 7 to 14 days, then 10 mg/kg orally every 2 to 3 days for 2 to 8 weeks

Pulse regimen: 10 mg/kg orally 4 times a day, then rifaximin OR nitazoxanide

Comments:

Use: Treatment of C difficile infection

Usual Pediatric Dose for Enterocolitis

Oral solution:
Less than 18 years: 40 mg/kg orally in 3 to 4 divided doses


Comments:

Uses:

AAP Recommendations:
Children:
FIRST OCCURRENCE:
Mild-moderate infection:
Failure to respond within 5 to 7 days, pregnant/breastfeeding, OR metronidazole-intolerant patients: 10 mg/kg orally every 6 hours

Patients for whom oral therapy cannot reach colon: 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS oral metronidazole OR oral vancomycin

Severe infection: 10 mg/kg orally every 6 hours

Severe and complicated infection:
No abdominal distention: 10 mg/kg orally every 6 hours PLUS metronidazole

Complicated with ileus or toxic colitis and/or significant abdominal distention: 10 mg/kg orally every 6 hours PLUS 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS metronidazole

FIRST RECURRENCE:
Mild-moderate infection:
Failure to respond within 5 to 7 days, pregnant/breastfeeding, OR metronidazole-intolerant patients: 10 mg/kg orally every 6 hours

Patients for whom oral therapy cannot reach colon: 500 mg (in 100 mL normal saline) rectally (as an enema) every 8 hours until symptoms improve PLUS oral metronidazole OR oral vancomycin

Severe infection: 10 mg/kg orally every 6 hours

SECOND RECURRENCE:
Tapered regimen:

Alternative tapered regimen: 10 mg/kg orally 4 times a day for 14 days, then 10 mg/kg orally 2 times a day for 7 to 14 days, then 10 mg/kg orally every 2 to 3 days for 2 to 8 weeks

Pulse regimen: 10 mg/kg orally 4 times a day, then rifaximin OR nitazoxanide

Comments:

Use: Treatment of C difficile infection

Usual Pediatric Dose for Skin or Soft Tissue Infection

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

Use:

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours
Invasive MRSA infections: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:

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

Comments:

Use:

Usual Pediatric Dose for Pneumonia

Neonates (Up to 1 month):
Initial dose: 15 mg/kg IV ONCE
Maintenance dose:


Pediatric patients (1 month and older): 10 mg/kg IV every 6 hours

Comments:

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:

Usual Pediatric Dose for Intraabdominal Infection

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours
Invasive MRSA infections: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:


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:

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:

Usual Pediatric Dose for Peritonitis

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours
Invasive MRSA infections: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:


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:

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:

Usual Pediatric Dose for Surgical Prophylaxis

AAP Recommendations:
Neonates (72 hours) or older: 15 mg/kg IV ONCE

Uses:
Alternative agent for surgical prophylaxis in patients undergoing:


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:

Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:

Usual Pediatric Dose for Meningitis

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours

Infants and Children:
Meningitis: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:


IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours

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

Usual Pediatric Dose for CNS Infection

AAP Recommendations:
Empiric treatment: 45 to 60 mg/kg/day, given in divided doses via IV every 6 to 8 hours

Infants and Children:
Meningitis: 60 to 70 mg/kg/day, given in divided doses via IV 4 times a day

Uses:


IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours

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:


Comment: 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


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:


Severe renal dysfunction and functionally anephric patients:

Patients with anuria:

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)

AAP, ASHP, IDSA, PIDS, and SIDP Recommendations:
Patients with suspected/definitive serious MRSA infections: 24-hour AUC level of 400 to 600 mg*hr/L (assuming a drug MIC of 1 mg/L)

Trough levels (1 to 2 hours after dosing):


Obesity:
Children:

Adults:

Comment: Children may require higher doses; patients may require more frequent therapeutic monitoring.

Precautions

US BOXED WARNINGS:
POTENTIAL RISK OF EXPOSURE TO EXCIPIENTS DURING EARLY PREGNANCY:

Recommendation:

CONTRAINDICATIONS:

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:


ISPD Recommendations:
Peritoneal Dialysis:
Pediatric patients:

AAP, ASHP, IDSA, PIDS, and SIDP Recommendations:
Adults:
Continuous Renal Replacement Therapy (CRRT):

Hybrid Dialysis:

Intermittent Hemodialysis: Patients should have predialysis serum concentration monitoring performed at least once a week

Other Comments

Administration advice:


Storage requirements:

Reconstitution/preparation techniques:

IV compatibility: The manufacturer product information should be consulted.

General:

Monitoring:

Patient advice:

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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