Vancomycin Dosing Calculator
Co-developed by Matthew Girgis - ID PharmD trained in Boston, currently
fighting drug resistant bugs in Toronto, Canada.
Select method of dosing
Calculate an empiric regimen
Two levels at STEADY STATE
Two levels after the FIRST dose
Two levels -time difference (hrs)-Quick method
derived or based on levels
Levels (if available) - Select
option above first
Ignore if levels available. Background information
Ke= 0.00083 x CRCL + 0.0044
Ke =Vanco CL/Vd
Volume of Distribution:
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:
Always use Actual (total) weight for vanco dosing
Use Adjusted Body Weight for patients more than 20% over IBW
Amputations (Optional Field)
BKA - below the knee amputation
Entire leg amputated
Both legs amputated
Addition data required for further analysis.
mcg/ml Desired Trough:
Infusion time (ti):
0.25 (15 min)
[ AUC guided recommendations will appear on the results
Process form entries
This latest version is based on a comprehensive review of the most recent pharmacokinetic textbooks. Some of the sources used are listed here
Bauer LA. The Aminoglycoside Antibiotics. In Bauer LA, ed. Applied
Clinical Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical;
Bauer LA. Vancomycin. In Bauer LA, ed. Applied Clinical
Pharmacokinetics. 2nd ed. New York, NY: McGraw Hill Medical; 2008:207-298.
Burton ME, Shaw LM, Schentag JJ, Evans WE. Applied Pharmacokinetics &
Pharmacodynamics: Principles of Therapeutic Drug Monitoring. 4th ed.
Philadelphia: Lippincott Williams & Wilkins; 2006.
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.
Murphy JE. Aminoglycosides. In: Murphy JE, ed. Clinical Pharmacokinetics, 4th
ed. Bethesda, MD: American Society of Health-System Pharmacists, 2008:27-60.
Winter ME. Basic clinical pharmacokinetics. 5th ed. Baltimore: Lippincott
Williams and Wilkins; 2010.
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. [
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
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.
Related pharmacokinetic calculators
Allows the user to estimate the actual (extrapolated) trough based on the elimination rate constant and the number of hours the level was drawn before the next scheduled dose. A
supratherapeutic level may be actually therapeutic if it was drawn just before the next dose.
This new program can be used to determine when to administer the next dose of vancomycin after a supratherapeutic trough is obtained. An estimated elimination rate
constant is generated from the creatinine clearance which is then used to determine the timing of the next dose based on the desired target trough concentration.
Use this program if the vancomcyin level is drawn early and you want to estimate the actual trough just before the next dose to determine if the current regimen is
Dosing by levels
Vancomycin – Single-level dosing
If you would like to enter the time since the last dose was given, use this version. This new version may be especially useful if the trough was drawn late and thenext dose was
delayed. Example: current regimen vanco 1 gram q12h. Trough wasdrawn 12.5 hours after the last dose.
The GlobalRPh vancomycin single-level calculator uses the Vd recommended in Bauer’s text: 0.7 L/kg. Use the advanced version if you wish to manipulate this value.