Vancomycin

First Dose: 25-30 mg/kg infused no greater than 10 mg/min

	Loading dose of IV vancomycin (Infuse at 10 mg/minute)
Patients actual body weight*	50 kg (up to 60kg)	60 kg (up to 80kg)	80 kg (up to 100 kg)	100 kg
LOADING DOSE	1.25 gram	1.5 gram	2 gram	2.5 gram
Likely infusion time	~2 hours	~2.5 hours	~ 3 hours	~4 hours

*Example loading doses. For patients greater than 100kg dose as per actual body weight and consult ID as patients > 150kg may need to be capped as infusion times will be > 6 hours

Subsequent doses and interval are determined by actual body weight and estimated GFR:

> 90 mL/minute:	20 mg/kg IV,	12-hourly
60-90 mL/minute:	15 mg/kg IV,	12-hourly
20-60 mL/minute:	15 mg/kg IV,	24-hourly
< 20 mL/minute:	15 mg/kg IV,	48-hourly

Trough levels are required for therapy > 48 hours (target 15-18 mg/L)

## For obese patients use actual body weight, this may need to be capped, for patients > 150kg seek expert advice as infusion times may be excessively long