Intravenous Vancomycin Dosages: Your GoodRx Guide
Key takeaways:
Vancomycin is an antibiotic that’s infused into a vein (IV) in a hospital setting to treat certain bacterial infections. Your IV vancomycin dosage is calculated based on your body weight. Vancomycin levels are monitored and adjusted throughout treatment to ensure they stay within a safe range.
You may need a higher IV vancomycin dosage if your body mass index (BMI) is over 30. Older adults and people living with kidney problems may need a lower IV vancomycin dosage to prevent levels from going too high.
Each dose of vancomycin should be infused over a minimum of 60 minutes (1 hour). This helps prevent an infusion reaction known as vancomycin flushing syndrome.
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Vancomycin is an antibiotic that treats certain bacterial infections. In most cases, you’ll receive vancomycin in a hospital setting, because it needs to be infused into a vein. Oral vancomycin isn’t absorbed well, and mostly stays in your stomach and intestines after you swallow it. So it’s only effective for infections in your intestines, such as Clostridioides difficile colitis.
Intravenous (IV) vancomycin enters your bloodstream directly, so it can fight off infections outside of your gut. Here, we’ll review the recommended IV vancomycin dosages for adults and children.
What’s the typical IV vancomycin dosage for adults?
Vancomycin is given as an IV to treat bacterial infections. It’s often reserved for serious infections, such as methicillin-resistant staph aureus (MRSA).
The usual IV vancomycin dosage for adults is 500 mg every 6 hours or 1 gram every 12 hours (2 grams per day). A more recent guideline recommends weight-based dosing of vancomycin. For most adults, the recommended IV vancomycin dosage is 15 mg to 20 mg per kg of body weight every 8 to 12 hours.
In some cases, you may receive a continuous infusion of vancomycin instead of individual doses throughout the day. In this case, the usual dosage is 30 mg to 40 mg per kg of body weight per day, up to a maximum of 60 mg per kg daily.
If you’re over the age of 65, you may be more sensitive to vancomycin’s side effects. So you may start with a lower IV vancomycin dosage as a precaution.
Good to know: Vancomycin given IV has a narrow therapeutic index. This means there is a small window between an effective dose and a toxic dose. So vancomycin requires therapeutic drug monitoring while you’re receiving it. Your healthcare team will take regular blood samples to check your vancomycin levels. They’ll adjust your dosage as needed to ensure the levels stay within a safe range and minimize the change of side effects. Your dosage will be individualized and may differ from the general dosages described above.
What’s the typical IV vancomycin dosage for children?
The typical IV vancomycin dosage for children ages 3 months to 11 years of age is 60 mg to 80 mg per kg of body weight daily. The daily dose will be divided into 4 smaller doses given every 6 hours.
For children ages 12 and older, 60 mg to 70 mg per kg of body weight daily is the recommended IV vancomycin dosage. The daily dose can be divided and given every 6 or 8 hours.
Most children shouldn’t need more than 3,000 mg of IV vancomycin daily, and doses over 3,600 mg daily aren’t recommended.
Infants who are younger than 3 months old will receive an IV vancomycin dosage of 10 mg to 20 mg per kg of body weight every 8 to 48 hours.
MRSA treatments: Methicillin-resistant staph aureus (MRSA) is a superbug that can be hard to treat. Learn more about MRSA and which antibiotics work best to treat it.
C. Diff and antibiotics: Clostridioides difficle (C. diff) colitis is an infection that can happen after taking antibiotics. Here’s why it happens and how it’s treated.
Sepsis 101: Sepsis is a medical emergency. Review what sepsis is and how to recognize it here.
Are there any dosage adjustments for medical conditions?
As mentioned, your vancomycin dosage will be adjusted as needed based on your blood levels throughout treatment. But certain health conditions may start with a different IV vancomycin dosage than described above.
Obesity
Carrying extra body weight can affect the way vancomycin is absorbed. If your body mass index (BMI) is 30 or more (or above the 95th percentile for children), you may need a higher vancomycin dosage. In some cases, this may include a one-time loading dose to get your levels up faster.
Kidney problems
Vancomycin is cleared from the body by your kidneys. So if you have kidney problems, it may be harder for your body to remove it. Your vancomycin dosage will be calculated based on your kidney function then monitored closely to ensure levels stay within a safe range.
How is IV vancomycin administered?
In most cases, vancomycin is infused into a vein at a rate of about 10 mg per minute. It should take at least 60 minutes (1 hour) to administer one dose of vancomycin. This is because vancomycin may cause an allergic reaction known as vancomycin flushing syndrome (VFS) if it’s administered too quickly.
VFS causes a red, itchy rash on your face, neck, and upper torso. It may also cause weakness and chest or back pain. VFS usually appears within the first 10 minutes of treatment. But it can appear up to 7 days after receiving IV vancomycin in some cases. So be sure to let your healthcare team know if these symptoms appear. In most cases, it’s easily managed with antihistamines once the infusion is stopped.
If you experience VFS and need to continue treatment with vancomycin, you’ll likely receive antihistamines before each dose. And your doses may be given over 2 to 4 hours.
What side effects are possible with IV vancomycin?
Common side effects of IV vancomycin include nausea, diarrhea, and infusion reactions (as described above). Rare, but serious reactions can include kidney damage, hearing loss, and low blood cell counts.
Your vancomycin levels will be closely watched and adjusted as needed during treatment to lessen the chance of serious side effects. Your healthcare team will also keep an eye on your kidney function throughout treatment.
The bottom line
Vancomycin is an antibiotic used to treat certain bacterial infections. It’s typically given in a hospital setting by intravenous (IV) infusion. Your IV vancomycin dosage is calculated based on your body weight. Vancomycin levels are monitored throughout treatment to ensure they stay within a safe range. Your IV vancomycin dosage will be individualized throughout treatment based on these levels.
Adults typically receive an IV vancomycin dosage of 15 mg to 20 mg per kg of body weight every 8 to 12 hours. For children ages 3 months and older, doses range from 60 mg to 80 mg per kg of body weight every 6 or 8 hours. Younger infants require more customized dosages and less frequent dosing.
You may need a higher IV vancomycin dosage if your BMI is over 30. Older adults and people living with kidney problems may need a lower IV vancomycin dosage to prevent levels from going too high.
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References
Centers for Disease Control and Prevention. (2022). About Child & Teen BMI.
Eugenia US LLC. (2021). Vancomycin hydrochloride - vancomycin hydrochloride injection, powder, lyophilized, for solution [package insert].
Martel, T. J., et al. (2023). Vancomycin flushing syndrome. StatPearls.
National Center for Biotechnology Information. (2024). PubChem compound summary for CID 14969, Vancomycin. National Library of Medicine.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Vancomycin. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
Pai, M. P., et al. (2014). Innovative approaches to optimizing the delivery of vancomycin in individual patients. Advanced Drug Delivery Reviews.
Patel, S., et al. (2023). Vancomycin. StatPearls.
Rybak, M. J., et al. (2020). Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy.
Shenoy, B., et al. (2023). Vancomycin therapeutic drug monitoring. Pediatric Infectious Disease.
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