Vancomycin Dose Calculator

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Important! Ensure all required patient data are entered accurately before proceeding. All dose calculations are for adult patients only.

Patient Inputs

Body Weight (BW) (kg):

Dialysis Status:

Creatinine Clearance (CrCl) (ml/min):

Vancomycin-Dialysis Timing:

Indication of Vancomycin:

Type of IV Access Available:

Summary of Inputs

STEP 1: Loading Dose (LD)

💡 Notes:

Loading Dose – To be given to ALL patients regardless of renal function.
Max Vancomycin dose: 2 g/DOSE.
If HD occurs on the same day as the loading dose, administer a TOP-UP DOSE post-HD.

STEP 2: Maintenance Dose (MD) & Frequency

STEP 3: Administration (Dilution & Infusion Rate)

3.1 Loading Dose Dilution & Administration:

3.2 Maintenance Dose Dilution & Administration:

💡 Maximum Infusion Rate:

Do not exceed 10 mg/min.
Infusing too rapidly may cause infusion-related reactions (Red Man Syndrome).

Step 3.3 – Special Warnings & Adjustments

! Vancomycin Infusion Reaction (VIR / "Red Man Syndrome")

VIR is a common infusion-related reaction, not an allergy.
Symptoms: Itching, flushing, and erythematous rash involving the face, neck, or upper trunk.
Management:
- Stop or slow the infusion rate — symptoms usually resolve.
- Antihistamines (e.g., chlorpheniramine or diphenhydramine) may help if symptoms persist.
- For subsequent doses, infuse at ≤ 10 mg/min to minimize recurrence.

! Fluid Volume Considerations - High Dilution Volume Advisory

For patients with fluid restrictions or heart failure, consider alternative dilution strategy or slower infusion rate.

! Phlebitis / Peripheral Line Irritation Risk

Peripheral administration of vancomycin may cause local irritation or phlebitis, particularly at higher concentrations. Use the largest available vein and monitor the site for redness, pain, or swelling.

STEP 4: Therapeutic Drug Monitoring (TDM) Guidance

4.1. When to Take the First TDM Sample

4.2. Do you need a post-dose (Peak) level?

💡 General Advisory:

If the sampling time falls after office hours (AOH), it is recommended to collect the sample the following morning.
Documentation Reminder: TDM results are meaningless unless:
1. The prescribed dose was correctly administered, and
2. The exact timing of infusion and sampling is accurately recorded.

Record all relevant details in the 📄 Vancomycin AUC Monitoring Form

STEP 5: Patient / Laboratory Monitoring

Monitor renal profile (RP) and urine output regularly.
Ensure the patient remains well hydrated while on Vancomycin.
Avoid concomitant nephrotoxic agents where possible.
Monitor WBC, CRP & Vital Signs for signs of improvement/deterioration.

Clinical Note Section (Auto-Generated)

Disclaimer! This note is intended as a template only — please review and adjust it based on your clinical assessment and professional judgement.

VANCOMYCIN THERAPY RECOMMENDATION

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Received query from Dr regarding IV Vancomycin initiation for this patient.

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PATIENT SUMMARY

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RECOMMENDED REGIMEN

LOADING DOSE:

MAINTENANCE DOSE:

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TDM SAMPLING

- TDM instructions not generated.

IMPORTANT:

- TDM blood sample should be obtained via venipuncture whenever possible, from the arm opposite to drug administration.

- Do not collect TDM samples from central lines (e.g. PICC, CVC, or other central venous catheters).

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REMARKS

- Monitor renal profile (RP) and urine output regularly.

- Ensure the patient remains well hydrated while on Vancomycin.

- Avoid concomitant nephrotoxic agents where possible.

- Infusion rate must not exceed 10 mg/min to minimize infusion-related reactions.

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Vancomycin Calculator Disclaimer

Recommendation is based on Hospital Sungai Buloh Vancomycin Protocol. 🔗 Refer to Hosp Sungai Buloh Vancomycin Protocol.
Clinical correlation is required.
If in any doubt, call TDM Pharmacy (Ext: 4124) or refer to Infectious Disease (ID).
Referral to ID or AMS Team is strongly recommended for all MRSA or Vancomycin cases.

Vancomycin TDM Sampling Guide

Calculate optimal sampling times for therapeutic drug monitoring.

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Disclaimer: This guide is NOT APPLICABLE to patients on renal replacement therapy (RRT) or haemodialysis.

TDM Sampling Parameters

Vancomycin Regimen:

Loading Dose · Optional

Maintenance Dose · Required

📅 Date & time of FIRST maintenance dose:

Sampling Method: ▶ Select one to proceed

TROUGH ✓

Pre-dose sampling only

Trough — Pre-dose sampling only. Recommended for:

CNS infections
Skin & soft tissue infections (SSTI)
Urinary Tract Infection (UTI)
MRCoNS infection
Enterococcus infection

AUC ✓

Pre-dose + Post-dose sampling

AUC — Pre-dose + Post-dose sampling. Recommended for MRSA infection of:

Bacteremia
Endocarditis
Pneumonia
Bone / Joint Infection
Neutropenic fever

Developed by Izyana Munirah Idham (AMS Pharmacist), Hospital Sungai Buloh.

Collaborators Nur Farhana (TDM Pharmacy), Hannah Md Mahir, Fong Siew Li & Muhammad Zulhafiz (AMS Pharmacists), PRIC, Medication Safety Team, JK IT & Digital (Pharmacy Dept, HSgB).

Approved by Dr Syamhanin Adnan (Head of Pharmacy Dept, HSgB).

Launched Apr 2026.

For Hospital Sungai Buloh Staff Use Only.

This calculator provides general guidance based on the HSgB Vancomycin Protocol to support standardised practice in Hosp Sungai Buloh. It may not cover all clinical scenarios. Healthcare practitioners should review individual patient details and use professional judgment when applying this guide.

📝 Feedback: We welcome your feedback to improve this tool. Click here to submit feedback

VDOSE

📋 Disclaimer & Terms of Use

VDOSE

Vancomycin Dose Calculator

Patient Inputs

Summary of Inputs

STEP 1: Loading Dose (LD)

STEP 2: Maintenance Dose (MD) & Frequency

STEP 3: Administration (Dilution & Infusion Rate)

3.1 Loading Dose Dilution & Administration:

3.2 Maintenance Dose Dilution & Administration:

STEP 4: Therapeutic Drug Monitoring (TDM) Guidance

4.1. When to Take the First TDM Sample

4.2. Do you need a post-dose (Peak) level?

STEP 5: Patient / Laboratory Monitoring

Clinical Note Section (Auto-Generated)

Vancomycin Calculator Disclaimer

Vancomycin TDM Sampling Guide

TDM Sampling Parameters

Summary of Inputs

TDM Sampling Recommendations

Clinical Note Template