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IV: intravenous; IHHD: intermittent high-flux hemodialysis.
* A maximum loading dose of 3 grams may be given; however, many use a loading dose of no more than 2 grams (especially in older patients and in patients with nonsevere infection).
¶ If morbidly obese, an adjusted dosing weight is suggested. A calculator to determine adjusted dosing weight is available in UpToDate.
Δ In patients receiving IHHD, the differences between actual body weight pre-dialysis ("wet weight") and post-dialysis "dry weight" can be up to 3 kg. We use actual body weight (usually available at the time of ordering) for determination of the initial supplemental dose; subsequent supplemental doses are determined by pre-dialysis concentrations utilizing fixed dosing ranges (rounded to increments of 250 mg) so are not dependent on patient weight.
◊ In critically ill patients or other concern for altered pharmacokinetics (eg, residual renal function, acutely post-transplant), a pre-dialysis vancomycin concentration should be assessed prior to each dialysis session until stable dosing has been established.
§ The vancomycin serum concentration should be repeated prior to each subsequent dialysis session until it falls below 30 mcg/mL, at which time vancomycin administration during the last 2 hours of hemodialysis should be resumed with dose reduction of 500 to 1000 mg. Following dose adjustment, repeat vancomycin serum concentration should be measured prior to the following dialysis session, with subsequent adjustment (if necessary) as summarized above.Do you want to add Medilib to your home screen?