Intermittent vancomycin dosing in children
The following vancomycin regimens are intended for initial therapy only (up to 48 hours). Modify the dosage when the child’s vancomycin plasma concentration is available.
For initial dosing in children without abnormal kidney function, use:
vancomycin 15 mg/kg (actual body weight) up to 1 g intravenously, 6-hourly. Maximum daily dose 4 g. See advice on plasma concentration monitoring and dosage adjustment. vancomycin vancomycin vancomycin
For initial dosing in children with abnormal kidney function, give a single vancomycin dose and seek expert advice for subsequent dosing; use:
vancomycin 15 mg/kg (actual body weight) up to 1 g intravenously, as a single dose. Seek expert advice for timing of the next dose. vancomycin vancomycin vancomycin
Some institutions use 12-hourly vancomycin dosing for children. There are limited data informing monitoring requirements when 12-hourly dosing is used in children. The monitoring advice provided in these guidelines only applies when 6-hourly dosing is used in children – it should not be extrapolated to 12-hourly dosing.
For children with obesity (body mass index [BMI] above the 95th percentile for their age and sex), there are limited data to guide vancomycin dosing. Both the volume of distribution and the clearance of vancomycin are increased in obesityAlobaid, 2016. Although, vancomycin doses based on actual body weight may result in high plasma concentrationsKhare, 2020, it is the consensus view of the Antibiotic Expert Group that vancomycin dosing based on actual body weight is appropriate for children with a BMI above the 95th percentile but below the 99th percentile for their age and sexLe, 2015. For children with a BMI above the 99th percentile for their age and sex, seek expert advice. Careful plasma concentration monitoring is essential to optimise dosing and minimise toxicity in children with obesity.