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https://doseme-rx.com/vancomycin/articles/infusion-guidelines
Infusion-related reactions are related to both the concentration of vancomycin and the rate of infusion. To minimize these adverse reactions, vancomycin should be diluted before it is administered as per the product insert, and infused slowly over a period of at least one hour, or at an infusion rate of 10mg/min or less.
https://www.stonybrookmedicine.edu/sites/default/files/Vanco_Cont_Inf_RPh_Info_080718_0.pdf
“Random” level taken 24 hours after the same continuous infusion rate in a patient with vancomycin half-life 4-6 hours reflects steady state “Plateau” vancomycin concentration Target “Random” level: 20-30 mcg/mL (AUC0-24 of 480 to 740 mg*h/L)
https://health.ucdavis.edu/antibiotic-stewardship/pdfs/vanc_dosing.pdf
Vancomycin Continuous Infusion (CI) A. Background 1. May be renal protective compared to troughs of 15-20mcg/ml via intermittent dosing 2. (i.e. ClCr > 120 Effective method to achieve adequate levels in pts with high elimination rates ml/min, e.g. burn, TBI, severe trauma) 3. Review need for continued vancomycin therapy (for 4 days or more) 4.
https://broomedocs.com/wp-content/uploads/2019/06/Vancomycin-CI-Protocol.pdf
EMPIRICAL VANCOMYCIN INFUSION for the first 24-hour bag: CrCl Daily (24-hr dose) Volume / rate < 20 No continuous infusion, discuss with renal team 20 – 29 500 mg 500 ml @ 21ml/h 30 – 39 750 mg 500 ml @ 21 ml/h 40 – 54 1000 mg 500 ml @ 21 ml/h
https://www.drugs.com/dosage/vancomycin.html
Intermittent infusion: 15 to 20 mg/kg IV per day, given in divided doses every 6 to 8 hours. Critically Ill Patients: Intermittent infusion: -Initial dose: 20 to 35 mg/kg IV ONCE. -Maximum dose: 3000 mg/dose. Continuous infusion: -Loading dose: 15 to 20 mg/kg IV ONCE. -Maintenance dose: 30 to 40 mg/kg via IV infusion.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050671s024lbl.pdf
concentrations of about 19 mcg/mL 2 hours after infusion, and mean plasma concentrations of about 10 mcg/mL 6 hours after infusion. The plasma concentrations during multiple dosing are similar to those after a single dose. The mean elimination half-life of vancomycin from plasma is 4 to 6 hours in subjects with normal renal function.
https://globalrph.com/dilution/vancomycin/
Further, vancomycin is very acidic - pH of ~ 3.4 (admixture). A 20 to 40 fold dilution of the reconstituted vial (1 gram/20 ml) will result in a negligible change in the pH ( ~+ 0.3). The primary purpose of the dilution is to facilitate a slower administration rate and to reduce the amount of drug present per unit of volume.
https://www.universityhealthsystem.com/~/media/files/clinical-pathways/vancomycin-dosing-guidelines-adults-2018.pdf?la=en
o 25-30 mg/kg of vancomycin as a continuous infusion over 24 hours Switching from intermittent dosing to CI vancomycin o **NOTE** patients on CI vancomycin tend to accumulate vancomycin and require a lower total daily dose than intermittent therapy . o If patient therapeutic on intermittent therapy: Add up total dose of vancomycin and reduce by ...
https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/pdf%20docs/Vancomycin%20Policy.pdf
5% may be used in patients with sodium restrictionInfusion Rate: Do not infuse faster than 500mg over 60 minutes (to avoid risk of vancomycin infusion reaction, pain or muscle spasm) Always state exact time of sample in relation to dose on request.
https://globalrph.com/medcalcs/vancomycin-single-level-original-calc/
A new program was created to determine when to administer the next dose of vancomycin after a supratherapeutic trough is obtained. An estimated elimination rate constant is generated from the creatinine clearance which is then used to determine the timing of the next dose based on the desired target trough concentration.
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