CrCl (mL/min) Vancomycin Dosing
> 70 mL/min 15 mg/kg every 8-12 hours
40 – 69 mL/min 15 mg/kg every 12-24 hours
20 – 39 mL/min 15 mg/kg every 24-48 hours
<20 mL/min 15 mg/kg x 1, then re-dose by level
HD/CAPD 15 mg/kg x 1, then re-dose by level
CVVH 1 g IV every 24 hours

Doses are based on actual body weight

  • Doses should be rounded to the nearest 250 mg (maximum 2 g per dose)

  • Consultation with an Infectious Disease specialist is strongly recommended for Staphylococcus aureus bacteremia (irrespective of source and susceptibilities)

Am J Health-Syst Pharm. 2009; 66:82-98


Trough serum concentrations are the most accurate and practical method for monitoring efficacy and avoiding adverse effects

  • Troughs should be obtained just prior to the next dose when patient at steady-state (usually before 4th or 5th dose)

  • Minimum serum trough levels should always be maintained >10mg/L

  • Minimum serum trough levels of 15-20 mg/L are recommended for complicated infections (endocarditis, osteomyelitis, meningitis, and staphylococcal pneumonia)