Version May 2024
| Premedication: Diphenhydramine 50 mg IV and hydrocortisone 100 mg IV 15 minutes prior to initiation of protocol, then every six hours throughout protocol | |||
| Infusion number | Dilution | Vancomycin dose (mg) | Concentration (mg/mL) |
| 1 | 1:10,000 | 0.02 | 0.0002 |
| 2 | 1:1000 | 0.2 | 0.002 |
| 3 | 1:100 | 2 | 0.02 |
| 4 | 1:10 | 20 | 0.2 |
| 5 | Standard | 500 | 2 |
| Preparation | |||
| 1. Prepare a standard bag of 500 mg vancomycin in 250 mL NS or D5W; label as infusion number 5, vancomycin 2 mg/mL. | |||
| 2. Draw up 10 mL of the standard vancomycin 2 mg/mL preparation and place in 100 mL bag of NS or D5W; label as infusion number 4, vancomycin 0.2 mg/mL. | |||
| 3. Draw up 10 mL of the 0.2 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 3, vancomycin 0.02 mg/mL. | |||
| 4. Draw up 10 mL of the 0.02 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 2, vancomycin 0.002 mg/mL. | |||
| 5. Draw up 10 mL of the 0.002 mg/mL solution and place in a 100 mL bag of NS or D5W; label as infusion number 1, vancomycin 0.0002 mg/mL. | |||
| Infusion rate directions | |||
| Initiate infusion rate at 0.5 mL/minute (30 mL/hour) and increase by 0.5 mL/min (30 mL/hour) as tolerated every five minutes to a maximum rate of 5 mL/minute (300 mL/hour). If pruritus, hypotension, rash, or difficulty breathing occurs, stop infusion and reinfuse the previously tolerated infusion at the highest tolerated rate. This step may be repeated up to three times for any given concentration. | |||
| Upon completion of infusion number 5, immediately administer the required dose of vancomycin in the usual dilution of NS or D5W over two hours. Decrease rate if patient becomes symptomatic or, alternatively, increase rate if patient tolerated dose. Administer diphenhydramine 50 mg orally 60 minutes prior to each dose. | |||
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