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Vancomycin Dosing Calculator (beta)

Co-developed by Matthew Girgis - ID PharmD trained in Boston, currently fighting drug resistant bugs in Toronto, Canada.

Select method of dosing

AUC Target:   0-24

Multi-calc: Empirically derived or based on levels

Patient:     Location:  
Age:     Sex    Serum Creatinine    
Height
:      Weight:

Levels (if available) - Select option above first

Empiric only

Ignore if levels available.    Background information


Elimination rate constant:


Volume of Distribution:
Select Vd:led     L/kg

- Normal = 0.65
- Obese = 0.5
- Dehydrated = 0.6
- Overhydrated = 0.7-0.85
- Septic Shock/ICU/Trauma = 0.7-0.75
- Pregnant in 3rd Trimester or <48h post partum = 0.7

Modifications to the Vd based on body weight:

Amputations (Optional Field)

(optional)

Addition data required for further analysis.

Desired Peak:   mcg/ml    Desired Trough:   mcg/ml

Infusion time (ti): led   Info
[AUC guided recommendations will appear on the results page]

Process form entries


References


This latest version is based on a comprehensive review of the most recent pharmacokinetic textbooks. Some of the sources used are listed here
  1. Bauer LA. The Aminoglycoside Antibiotics. In Bauer LA, ed. Applied Clinical Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical; 2008:97-206.

  2. Bauer LA. Vancomycin. In Bauer LA, ed. Applied Clinical Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical; 2008:207-298.

  3. Burton ME, Shaw LM, Schentag JJ, Evans WE. Applied Pharmacokinetics & Pharmacodynamics: Principles of Therapeutic Drug Monitoring. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.

  4. DiPiro JT, Spruill WJ, Wade WE, Blouin RA, Pruemer JM. Concepts in Clinical Pharmacokinetics, (5th Edition) 2010. American Society of Health Systems Pharmacist, Bethesda, MD.

  5. Murphy JE. Aminoglycosides. In: Murphy JE, ed. Clinical Pharmacokinetics, 4th ed. Bethesda, MD: American Society of Health-System Pharmacists, 2008:27-60.

  6. Winter ME. Basic clinical pharmacokinetics. 5th ed. Baltimore: Lippincott Williams and Wilkins; 2010.

  7. Rybak MJ, Le J, Lodise TP,Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring of vancomycin: A revised consensus guideline and review of 1the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. Accessed: May 2019. [Link]
  8. Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy 2012; 32: 604-612 [PMID: 22576791 DOI: 10.1002/j.1875-9114.2012.01098.x]

    Quotes: [Largest study so far....total of 3678 patients]
    Regarding Salazar equation: This equation, however, was not consistently shown in studies to be a superior predictor of renal function. It is not widely used in clinical practice and has not been validated in pharmacokinetic studies. In addition, the Salazar-Corcoran equation is not recognized by the National Kidney Foundation.

    Regarding CG -LBW equation: Our findings do not support those conclusions and are different from a recent investigation of Clcr in 54 morbidly obese patients that found that adjusting an obese patient’s weight to a fat-free weight or lean body weight predicted a Clcr calculated with the C-G equation without bias. Notably, our study included 2065 obese or morbidly obese patients, far more than other published studies. 

    Conclusions: An unbiased C-G Clcr can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW0.4 for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C-G Clcr. Rounding Scr in patients with low Scr did not improve accuracy or bias of the Clcr calculations.  top of page

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