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Child Health Guideline Identifier


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Vancomycin is a restricted antibiotic and requires approval for use from the Paediatric Infectious Diseases team.

Vancomycin is used for:

  • treatment of serious Gram-positive infections including methicillin-resistant staphylococcus aureus (MRSA).

Initial dosing 

  • Neonates: Refer to Newborn Services clinical guidelines
  • Children:15mg/kg (based on Actual Body Weight) IV q6h
  • 20mg/kg q8h may be used in some situations (eg Paediatric Intensive Care)
  • Usual initial maximum daily dose - 3 g.  Higher doses of up to 6g may be used in certain cases on advice of the Paediatric Infectious Diseases team
  • Dose adjustment is needed in patients with renal dysfunction - please consult pharmacy
  • In serious, complicated or deep invasive infections consider using a loading dose of 20mg/kg (max 2g) followed by maintenance dosing 6 hours later of 15mg/kg q6h or a continuous infusion on advice of the Paediatric Infectious Diseases team.       


  • Monitor serum creatinine
  • Take initial vancomycin trough level at least 24 hours after commencement of vancomycin, immediately prior to the next dose.   Subsequent levels should be taken every 1-3 days depending on renal function and 24 hours after each dose change.
  • Levels should not be taken from the same line as vancomycin is administered through.
  • Aim for trough levels:
    - Normal range (trough): 10-20mg/L
    - Serious / proven MRSA (trough): 15-20 mg/L
    - Continuous infusions (random): 20-25 mg/L
  • In patients with normal renal function do not wait for the trough concentration result before giving the next scheduled dose

Adverse effect - Red-Man Syndrome

This is usually red flushing of the skin but symptoms include itching, low blood pressure and wheezing. It is due to the vancomycin infusion being too rapid. Vancomycin should be diluted to at least 5mg/mL for peripheral administration, and infused at a rate of not more than 10mg per minute.

Dosage adjustments

The following dose adjustments are for intermittent dosing not continuous infusion. For dose adjustments for patients with continuous infusions discuss with the Paediatric Infectious Diseases team or pharmacist.

Trough (mg/L) Action Dosage adjustment
<5* Adjust dose Increase dose by 75%
5-10 Adjust dose Increase dose by 25%
10-15 Maintain this level for uncomplicated non MRSA infections. Otherwise, increase dose by 25%
15-20 Keep same dose
21-25 Adjust dose Decrease dose by 25%
>25* Withhold next dose. Repeat level 6 hourly until trough below 20mg/L Dose reduction 25-50%
>30 Withhold next dose and consult with Infectious Diseases Team or antimicrobial pharmacist for advice. 

*If unexpected result (very high or very low) check that the timing of the trough sample was appropriate, consider whether steady state concentration has been reached, whether patient's renal function is rapidly changing or if sample taken from a line where infusion of vancomycin had been delivered.

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Document Control

  • Date last published: 01 December 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Infectious Diseases
  • Author(s): Emma Best
  • Editor: Greg Williams
  • Review frequency: 2 years

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