AUC-Targeted Vancomycin EMPIRIC Dosing Nomogram

AUC-Guided Vancomycin Dosing SOFTWARE (integrated in Vigilanz)

Policies and procedures

Procedure M-19.3 Intraventricular Infusions

Procedure M-19.4 Intrathecal Infusions

Consults, protocols, and therapeutic interchanges

System_RXCLIN 129 Pharmacy Consult for Pharmacokinetics – Vancomycin and Aminoglycosides

Key Points:

• Pharmacists will evaluate indication and current patient status and will optimize dosing and monitor labs “per policy”
• Pharmacists will document in Epic using i-Vents at least daily and using consult notes at least once weekly on Thursdays

Additional information

Houston Methodist Antimicrobial Stewardship page

Important information for vancomycin administration:

• Administer vancomycin at the proper infusion rate (each 500 mg over 30 minutes)
• DO NOT hold vancomycin doses while waiting for level results, unless specified by the prescriber
• Be aware of when trough levels should be drawn (~30 minutes prior to the dose). If you have to reschedule a dose for an unavoidable reason, please contact your pharmacist to retime the level
• Oral vancomycin is not absorbed systemically and is only indicated for the treatment of C. difficile infection

Table. Infusion duration if concentration is less than or equal to 5 mg/ml

• Micromedex
• UpToDate
• Lexicomp