Commonly used drugs in transplant patients:
Antibiotics
Dosage
The usual IV dose of vancomycin for adults with normal renal function is 1 g every 12 hours (15 mg/kg) or 500 mg (6.5-8 mg/kg) every 6 hours. The intravenous dosage must be reduced in patients with renal impairments and monitored to achieve peak serum concentrations no higher than 30-40 m g/ml and troughs ranging from 5 to 10 m g/ml. If a continuous infusion or infrequent dosing is necessary, a steady-state concentration of 15 m g/ml seems desirable. Peak and trough levels should be checked after 5 half-lives or at the time the third dose is given. Normal half life of vancomycin is 6 hours, but it is progressively lengthened in renal dysfunction.
While vancomycin penetrates into the central nervous system in most ill patients in amounts to treat meningitis and shunt infections, removal of foreign bodies and supplemental intrathecal instillation of vancomycin may be required in patients with a poor response. CSF concentrations need not be greater than about 25 m g/ml, so intrathecal doses of 3 mg are usually adequate.
Dosage in patients with renal impairment
Loading dose = 15mg/kg
Maintenance dose : Select dose and dosing interval from the table based on creatinine clearance and body weight.
| |
40 – 55 kg |
55 – 75 kg |
> 75 kg |
Creatinine clearance (ml/min) |
500 mg |
1 g |
1.5 g |
81 -100 |
q 8 hours |
q 12 hours |
q 18 hours |
54 - 80 |
q 12 |
q 18 |
q 24 |
40 - 53 |
q 18 |
q 24 |
q 36 |
27 - 39 |
q 24 |
q 36 |
q 48 |
21 - 26 |
q 36 |
q 48 |
q 72 |
16 - 20 |
q 48 |
q 60 |
q 84 |
13 - 15 |
q 60 |
q 84 |
q 108 |
10 - 12 |
q 72 |
q 108 |
q 144 |
Management of Clostridium difficile enteritis
Although metronidazole is less expensive and also effective, oral vancomycin is considered the drug of choice for seriously ill patients with antibiotic-associated Clostridium difficile enteritis. Dosages of either 125 or 500 mg four times daily should be effective. Intravenous vancomycin is not as reliable. In patients with ileus, vancomycin should be given orally or by nasogastric tube in 500 mg every 6 hours, and both vancomycin in full parenteral doses and metronidazole should be given intravenously.
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