What adjustments should be made for administering vancomycin to patients receiving hemodialysis

What adjustments should be made for administering vancomycin to patients receiving hemodialysis?

It is important to load patients receiving dialysis with 15 to 20 mg/kg based on ABW. Maintenance doses will depend on the dialysis membrane used during hemodialysis.

Vancomycin Administration in Patients Undergoing Dialysis


HEMODIALYSIS (HD) (HIGH FLUX)
CONTINUOUS VENOVENOUS HEMOFILTRATION (HD, HEMODIAFILTRATION)PERITONEAL
Loading dose15–20 mg/kg dose based on actual body weight (ABW)
Note: Not to exceed 1500 mg
May consider 20 mg/kg in severe infections (i.e., meningitis, severe sepsis, endocarditis, osteomyelitis, and hospital-acquired pneumonia [HAP])
15–20 mg/kg dose based on ABW
Note: Not to exceed 1500 mg
May consider 20 mg/kg in severe infections (i.e., meningitis, severe sepsis, endocarditis, osteomyelitis, HAP)
Not necessary
Maintenance dose (postdialysis)<75 kg: 500 mg after HD for predialysis level <20
>75 kg: 1000 mg after HD for predialysis level <20
10–15 mg/kg every 24 h
Note: May consider higher doses in patients who are obese not to exceed 1500 mg Intravenous (IV) q24h
IP (intraperitoneal): 30 mg/kg loading dose
15 mg/kg every 3–5 days
Note: Patients that are not anuric may need to adjust dosing frequency because there is residual kidney function
IV: 15–20 mg/kg per dose
Serum level monitoringDraw serum level prior to the second HD session, then get random levels with am labs on HD days only (or q48 h)
Note: Subsequent serum levels should be drawn prior to every or every other HD session
Draw serum level prior to the second or third dose (approximately 24 h after last dose)
Note: May draw random daily levels with am labs
IP: Draw serum trough level 72 h after loading dose
IV: Draw serum trough level 48–72 h after initial dose
Dosing based on serum levelsIf pre-HD level is:
>20: hold dose
10–20: give dose after HD (based on weight)
<10: administer another loading dose after HD
If serum level is:
>20: hold dose
10–20: continue with q24h dosing
<10: 15–20 mg/kg loading dose → consider more frequent dosing or increasing the dose
If level is: >20: hold dose <20: administer anot
15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856
Scroll to Top