Vancomycin calculation tool

Review Vancomycin guideline AND Contact Pharmacy if any apply, as this tool will not give relevant advice.

Amputee

Pregnant

Paraplegia or quadriplegia

Rapidly changing kidney function

NONE of the ABOVE apply (tick to use tool)

Indication

Please choose a username.

On renal replacement therapy?

Yes No

Gender

Male Female

Age

Weight in kg (round to nearest kg)

Date Weight Taken (Weight must be measured within last 30 days)

Height in cm (round to nearest cm)

Serum Creatinine in µmol/L

I confirm that this tool takes no clinical responsibility for outcomes
and I will use this tool only to aid my ultimate clinical decision.

The indication for treatment is

Prescribe STAT dose of

The patient's BMI is

The patient's ideal body weight is

The CrCl =

Therefore prescribe

Do not wait for the result before giving the next scheduled dose unless CrCl < 10 ml/min or the patient is on renal replacement therapy

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Loading dose

Creatinine clearence (mL/min)	Vancomycin Maintenance dose	Dose interval	Time of 1st level	Monitoring Frequency
> 110	1500mg	12 hourly	Before 4th dose	If stable renal function, request levels TWICE weekly. Do not wait for results. If worsening renal function, request levels every 24 hours. Hold dose until result arrives.
90 - 110	1250mg	12 hourly	Before 4th dose
75 - 89	1000mg	12 hourly	Before 4th dose
55 - 74	750mg	12 hourly	Before 4th dose
40 - 54	500mg	12 hourly	Before 4th dose
30 - 39	750mg	24 hourly	Before 3rd dose
20 - 29	500mg	24 hourly	Before 3rd dose
10 - 19	500mg	48 hourly	Before 2nd dose
< 10	500mg	48 hourly (check level before giving)	24 hour intervals	24-hour intervals. Withhold dose if level is high and adjust dose / dosage interval accordingly
CRRT	Withold initiating maintenace dose until level is in range.	Maintenance dose can range between 500mg to 1500mg 24hourly. Adjust the dose or dosing interval to acheive the target range.	24 hour intervals