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Rapid vancomycin desensitization protocol

Rapid vancomycin desensitization protocol
Premedication: Diphenhydramine 50 mg IV and hydrocortisone 100 mg IV 15 minutes prior to initiation of protocol, then every 6 hours throughout protocol
Infusion number Dilution Vancomycin dose (mg) Concentration (mg/mL)
1 1:10,000 0.02 0.0002
2 1:1000 0.2 0.002
3 1:100 2 0.02
4 1:10 20 0.2
5 Standard 500 2
Preparation
  1. Prepare a standard bag of 500 mg vancomycin in 250 mL NS or D5W; label as infusion number 5, vancomycin 2 mg/mL.
  1. Draw up 10 mL of the standard vancomycin 2 mg/mL preparation and place in 100 mL bag of NS or D5W; label as infusion number 4, vancomycin 0.2 mg/mL.
  1. Draw up 10 mL of the 0.2 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 3, vancomycin 0.02 mg/mL.
  1. Draw up 10 mL of the 0.02 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 2, vancomycin 0.002 mg/mL.
  1. Draw up 10 mL of the 0.002 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 1, vancomycin 0.0002 mg/mL.
Infusion rate directions
Initiate infusion rate at 0.5 mL/minute (30 mL/hour) and increase by 0.5 mL/min (30 mL/hour) as tolerated every 5 minutes to a maximum rate of 5 mL/minute (300 mL/hour). If pruritus, hypotension, rash, or difficulty breathing occurs, stop infusion and reinfuse the previously tolerated infusion at the highest tolerated rate. This step may be repeated up to 3 times for any given concentration.
Upon completion of infusion number 5, immediately administer the required dose of vancomycin in the usual dilution of NS or D5W over 2 hours. Decrease rate if patient becomes symptomatic or, alternatively, increase rate if patient tolerated dose. Administer diphenhydramine 50 mg orally 60 minutes prior to each dose.
D5W: dextrose 5% in water; IV: intravenous; NS: sodium chloride 0.9% solution.
Reproduced with permission from: Wazny LD, et al. Desensitization protocols for vancomycin hypersensitivity. The Annals of Pharmacotherapy 2001; 35:1458. Copyright © 2001 Harvey Whitney.
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