Nephrotoxicity:
- Dose-dependent
- Ensure good hydration
- Avoid co-prescription of nephrotoxins (e.g. furosemide)
Other:
- Drug fever
- Eosinophilia
- Neutropenia (after cumulative dose of 25g)
- Tinnitus (discontinue)
28 june 2024
Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.
Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.
Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.
In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.
This guidance is for NHS Lothian staff wishing to use Vancomycin for adults.
DO NOT USE UNLESS ONLINE CALCULATOR IS UNAVAILABLE
Document doses and plan in TRAK using \vanc. If possible double-check with ward pharmacist. When online calculator is available, transcribe calculations onto chart.
Exclusions and contraindicationsDo not use this guidance in the following groups:
Contraindication:
Cautions:
Required monitoring
Nephrotoxicity:
Other:
1. Calculate Loading dose
This is based on the patient’s actual body weight.
Prescribe as a STAT dose
Actual body weight (kg) |
Dose (mg) |
Volume of sodium chloride 0.9% (Maximum concentration 5mg/ml) |
Duration of infusion |
<40 |
750 |
250ml |
1.5 hours |
40–59.9 |
1000 |
250ml |
2 hours |
60–90 |
1500 |
500ml |
3 hours |
>90 |
2000 |
500ml |
4 hours |
2. Calculate the patient's creatinine clearance
3. Calculate Maintenance doses
Maintenance dose depends on the patient’s Creatinine Clearance (Cockcroft-Gault)
CrCl (ml/min) |
Dose, volume of sodium chloride 0.9%*, duration |
Dosing Interval |
Time for 1st Trough level |
<20 |
500mg in 250ml over 1 hour |
48 hours |
Before 1st maintenance dose |
20-29 |
500mg in 250ml over 1 hour |
24 hours |
Before 2nd maintenance dose |
30-39 |
750mg in 250ml over 1.5 hours |
24 hours |
Before 2nd maintenance dose |
40-54 |
500mg in 250ml over 1 hour |
12 hours |
Before 3rd maintenance dose |
55-74 |
750mg in 250ml over 1.5 hours |
12 hours |
Before 3rd maintenance dose |
75-89 |
1000mg in 250ml over 2 hours |
12 hours |
Before 3rd maintenance dose |
90- 110 |
1250mg in 250ml over 2.5 hours |
12 hours |
Before 3rd maintenance dose |
>110 |
1500mg in 500ml over 3 hours |
12 hours |
Before 3rd maintenance dose |
3. Missed/delayed doses
If Dose delayed <1 hour after prescribed time, nursing staff can administer
Length of delay |
Recommended action |
More than 1 hour; Less than halfway to next dose (i.e. <6h if on if on 12h dosing) |
Re-prescribe missed dose as once only/STAT. Give the next vancomycin dose at the ORIGINALLY PRESCRIBED TIME |
More than 1 hour; More than halfway to next dose (i.e. >6h if on if on 12h dosing) |
Re-prescribe missed dose as once only/STAT. Seek advice from pharmacy for further dosing. |
4. Review ongoing need
If vancomycin is to be continued, monitor trough every 48-72 hours or as advised by the pharmacist
Recommended target trough levels:
10-15 |
15-20 |
|
Typically “deep seated” infections
|