Therapeutic Monitoring Of Vancomycin For Serious Methicillin-Resistant Staphylococcus Aureus Infections
Recommendations
Therapeutic Monitoring
- In patients with normal renal function, these doses may not achieve the therapeutic AUC/MIC target when the MIC is 2 mg/L.
- b. The preferred approach to monitor AUC involves the use of Bayesian software programs, embedded with a PK model based on richly sampled vancomycin data as the Bayesian prior, to optimize the delivery of vancomycin based on the collection of 1 or 2 vancomycin concentrations, with at least 1 trough. It is preferred to obtain 2 PK samples (ie, at 1 to 2 hours post infusion and at end of the dosing interval) to estimate the AUC with the Bayesian approach.
Vancomycin Susceptibility Testing
Continuous Infusion vs. Intermittent Infusion
Loading Doses
Dosing in Obesity
Renal Disease and Renal Replacement Therapies
Timing and Dialyzer Permeability | Vancomycin Dose, mg/kg |
---|---|
After dialysis ends | |
Low permeability | Loading: 25 Maint.: 7.5a |
High permeability | Loading: 25 Maint.: 10a |
Intradialytic | |
Low permeability | Loading: 30 Maint.: 7.5-10a |
High permeability | Loading: 35 Maint.: 10-15a |
Hybrid hemodialysis therapies
Concentration monitoring should guide further maintenance doses.
(, )Continuous renal replacement therapies
Pediatric Patients
Based on an AUC target of 400 mg·h/L (but potentially up to 600 mg·hr/L, assuming a vancomycin MIC of ≤1 mg/L for MRSA) from adult data, the initial recommended vancomycin dosage for children with normal renal function and suspected serious MRSA infections (including pneumonia, pyomyositis, multifocal osteomyelitis, complicated bacteremia, and necrotizing fasciitis) is:
- 60 to 80 mg/kg/day, in divided doses given every 6 hours, for children ages 3 months to less than 12 years or
- 60 to 70 mg/kg/day, in divided doses given every 6 to 8 hours, for those ≥12 years old.
Pediatric obesity
Neonates
Recommendation Grading
Overview
Title
Therapeutic Monitoring Of Vancomycin For Serious Methicillin-Resistant Staphylococcus Aureus Infections
Authoring Organizations
American Society of Health-System Pharmacists
Infectious Diseases Society of America
Society for Healthcare Epidemiology of America
Surgical Infection Society
Publication Month/Year
March 19, 2020
Last Updated Month/Year
February 5, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This consensus revision evaluates the current scientific data and controversies associated with vancomycin dosing and serum concentration monitoring for serious MRSA infections (including but not limited to bacteremia, sepsis, infective endocarditis, pneumonia, osteomyelitis, and meningitis) and provides new recommendations based on recent available evidence.
Target Patient Population
Patients with MRSA infections
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Hospital, Long term care, Outpatient
Intended Users
Epidemiology infection prevention, nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D000074389 - Therapeutic Index, Drug, D014640 - Vancomycin, D055624 - Methicillin-Resistant Staphylococcus aureus
Keywords
Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin, therapeutic drug monitoring, pharmacokinetics, Methicillin-Resistant Staphylococcus aureus
Source Citation
American Journal of Health-System Pharmacy, Volume 77, Issue 11, 1 June 2020, Pages 835–864, https://doi.org/10.1093/ajhp/zxaa036