Vancophar Dosage/Direction for Use

Route of Administration: For intravenous infusion and not for intramuscular administration.
Adults: Intravenous: The usual adult intravenous dose is 500 mg every six hours or 1 g every twelve hours, in Sodium Chloride 0.9% solution, Dextrose 5%. Each dose should be administered at no greater than 10 mg/min.
Staphylococcal infections normally respond within 48-72 hours. Duration of therapy depends on type and severity of infections and patient response. For bacterial endocarditis, the generally accepted regimen is 500 mg vancomycin intravenously every six hours for a minimum of three weeks either alone or in combination with other antibiotics.
Therapeutic range of serum levels: Following multiple intravenous doses, peak serum concentrations, measured 2 hours after infusion is complete, range from 18-26 mg/Liter. Trough levels measured immediately prior to the next dose should be 5-10 mg/liter. Ototoxicity has been associated with serum drug levels of 80-100 mg/Liter, but this is rarely seen when serum levels are kept at or below 30 mg/Litre.
Paediatric: Intravenous: The usual intravenous dosage is 10 mg/kg per dose given every 6 hours (total daily dosage 40 mg/kg of body weight). Each dose should be administered over a period of at least 60 minutes. In neonates and young infants, the total daily dosage may be lower. An initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours in the first week of life and every 8 hours thereafter until one month of age. Close monitoring of serum vancomycin concentrations may be warranted in these patients.
Geriatric: Because of its ototoxicity and nephrotoxicity, vancomycin should be used with caution in patients with renal insufficiency or previous hearing loss. The elderly are particularly at risk. Doses should be titrated on the basis of serum levels. Blood levels should be monitored and renal function tests performed regularly. The elderly are particularly susceptible to auditory damage and should be given serial tests for auditory function if over the age of 60. Concurrent or sequential use of other neurotoxic substances should be avoided. (See Precautions.)
With impaired renal function: In patients with impaired renal function, dosage regimen of vancomycin must be modified in response to degree of renal impairment, severity of infection, susceptibility of causative organism and serum concentrations of the drug. A suggested starting dose in patients with impaired renal function is 15 mg/kg with subsequent doses based mainly on renal function and serum concentrations of the drug.
Accumulation of the drug may occur with prolonged therapy and regular monitoring of serum levels should be carried out. The following guide is provided. This data is not valid for functionally anephric patients on dialysis. (See table.)

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In anephric patients, a loading dose of 15 mg/kg body weight should be given with subsequent dosage of 1.9 mg/kg/24hrs. Since individual maintenance doses of 250 mg-1 g are convenient in patients with marked renal impairment, a dose may be given every several days rather than on a daily basis. In anuria a dose of 1g every 7-10 days has been recommended.
In patients on haemodialysis, the drug is not significantly removed by haemodialysis. A dose of 1 g of vancomycin every seven days produces effective blood levels. Serum levels should be monitored to avoid drug accumulation and resultant toxicity. The serum half-life ranges from 120 to 216 hours.
In patients undergoing peritoneal dialysis, the half-life of vancomycin has been reported at around 18 hours. To prevent undue lowering of serum levels during peritoneal dialysis, an additional amount of vancomycin could be added to the dialysate in a concentration of 25 microgram per ml.