Vanco dosing considerations
Critically ill pt
As a rule, we have been using a minimum SCr of 0.8 in patients over 65 so as not to over estimate CrCl due to age-related decline in renal function. This may be causing some under dosing in our “not so old” elderly patients.
In patients over 65 with a SCr above 0.6, consider using actual SCr.·
Critically ill patients tend to have increased volume of distribution of vanco as well as increase clearance. With initial dosing, error on the “high side” ex. 750 mg IV q12h would give you a predicted trough of 16 mcg but 1 gm IV q12h predicts a trough of 21; in an acutely ill patient with stable RF, I would go with the 1 gm IV q12h, order a trough prior to the 4th dose, and adjust as necessary.·
Remember to order a Vancomycin loading dose