Disclaimer - Please see package insert
if applicable for additional information. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.Read the disclaimer
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Background information
A fellow clinician (Nathan Fewel, PharmD, BCPS), created a quick tool
that can be used to quickly generate an empiric regimen for vancomycin
with just a few data points. The pdf can be downloaded
here. The tool has
two separate charts. The top chart targets a trough of 15-20 mcg/ml and the
second dosage chart targets a trough of 10-15 mcg/ml. The tables
are based on the most common elimination rate equation for vancomyin:
Ke = 0.00083 (CrCl) + 0.0044. T1/2 = 0.693/ Ke. Infusion times
used (ti):
500 and 750mg = 1 hour; 1000 and 1250mg = 1.5 hours; 1500mg = 2 hours.
To help with the initial use of this tool, the author provided some
great examples. Dr. Fewel has extensive experience with
pharmacokinetics and the practical and clinical application of various
dosing regimens.
Age
Gender
Height (in)
Weight (kg). For patients >110 kg, use adjusted BW on
the nomogram to estimate V.
SCr (mg/dL).
CrCl. Use the CG equation with IBW to estimate CrCl,
except for patients >110 kg (use adjusted BW), and underweight
patients (use actual BW).
Predicted trough (goal trough range 15-20 mcg/mL)
56
M
70 in
90 kg
1.20
70 mL/min
1250mg q12h 35/18
60
M
68 in
120 kg (Obese; adjusted BW = 89 kg)
0.98
100 mL/min
1000mg q8h 31/18
72
M
74 in
130 kg (Obese; adjusted BW = 101 kg)
1.12
85 mL/min
1500mg q12h 34/16
80
M
67 in
60 kg (Underweight)
1.3
40 mL/min
1000mg q24h 41/17
55
F
68 in
52 kg (Underweight)
0.65
80 mL/min
750mg q12h 36/17
35
M
74 in
100 kg
0.95
Cap at 120 mL/min
1500mg q8h* 34/18
Important note:
*Monitor 1500mg q8h doses closely, and consider capping initial dose at
1250mg q8h in patients >50 years old.
40
F
68 in
82 kg
0.58†
Cap at 120 mL/min
1250mg q8h 37/19*
Important note:
†Consider rounding SCr up to 0.60 mg/dL if less than 0.60 mg/dL,
especially in patients greater than or equal to 65 years of age.
*When the
15-20mcg/mL nomogram predicts a trough of 19 mcg/mL, the 10-15 mcg/mL
nomogram may have a lower dosage regimen with a predicted trough of 15
mcg/mL for the same V and CrCl. The lower dose may be preferred
empirically in some cases based on clinical judgement.
75
M
71 in
98 kg
2.32
30 mL/min
1250mg q24h 35/18
78
M
69 in
85 kg
3.8
16 mL/min
Dose by random vanco levels when CrCl is less than 20-25
mL/min.
Note: The nomogram may also be useful for determining
a new dose when calculating a patient-specific Ke based on measured
trough levels. Plot the new Ke on the nomogram with the patient’s body
weight.
Author:
Nathan Fewel, PharmD, BCPS
Inpatient Pharmacist
Central Texas Veterans Health Care System
Temple, Texas
DISCLAIMER
Disclaimer - Please see package insert
if applicable for additional information. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.Read the disclaimer
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