Glycopeptide TDM

Question 1

Adult Loading Dose

Answer 1

25-30 mg/kg
- Use actual body weight

Question 2

Adult Maintenance Dose

Answer 2

15 mg/kg/dose
- Use actual body weight
- Is capped at 2 g

Question 3

When to draw Vancomycin

Answer 3

1. Not routienly drawn
2. Therapy longer than 7 days
3. BMI > 40
4. SrCr over 40 umol/L. SrCr increases 50% over baseline
5. Altered Volume of distribution (Cystic fibrosis, burns)
6. Severe infections that require a good level

Question 4

Vancomycin
- Severe Infections

Answer 4

Higher target of 15-20 mg/L
- CNS infections
- Pneumonia
- Endocarditis
- Osteomyelitis

• Sepsis
• Bacteremia
• Deep-Seated Infections

Question 5

TDM Questions

Answer 5

1. Calculate Loading Dose (30 mg/kg) (Max 2g)
2. Calculate Maintenance Dose (15 mg/kg/dose)
3. Calculate IBW and use Dosing Interval Nonagram

Question 6

TDM Answer Format

Answer 6

Dose:
- 2g IV loading dose right away. After 12 hours start 1g IV q12h (infused over 1 hour)
- Draw trough level before 3rd or 4th dose

Question 7

When to draw Trough

Answer 7

30 mins before next dose
- Before 4th dose

Question 8

What to monitor for

Answer 8

Signs of Otoxicity
Serum Creatinine
Neutrophil count

Question 9

Recommended:
- Trough
- Loading
- Maintenance

Answer 9

10-20 mg/kg

25-30 mg/kg

15 mg/kg/dose