Distribution characteristics of Vancomycin

 Vancomycin is a large glycopeptide compound with a molecular weight of about 1450

Da.
 It is not primarily absorbed orally and its primary route of elimination is kidney with
>80-90% being excreted unchanged in the urine within 24 hours after single dose
administration.
 Volume of distribution is 0.72L/kg and its protein binding fraction constitutes 10-
50%.
 In this scenario, the patient bearing normal creatinine clearance, an α distribution
phase of 30 minutes to 1 hour and a ß elimination half life of 6-12 hours is observed
(1 (1))

The dosing regimen is as follows based on ideal body weight;

Ideal body weight = 45.4 + 0.89 {height(cm) – 152.4}
= 45.4 + 0.89 {178-152.4}
= 68.184 kg

So, according to Loading dose formula of 20-25 mg/kg, loading dose for this patient
should be 1363.8 mg to 1704.6 mg.
Maintenance dose should be 15-25 mg/kg, ranging from 1022.76 to 1704.6 mg.

The dosing regimen based on Lean body weight is as follows:

Lean body weight = 9270 * 90/6680 + 216 (28.4)
= 65.1 kg

So, Loading dose would be 1302.12 mg to 1627.5 mg and maintenance dose would be
976.5 mg to 1627.5 mg ( (2,3)

References:

1. Rybak MJ. The Pharmacokinetic and Pharmacodynamic Properties of Vancomycin. Vol. 42, Clinical
Infectious Diseases. 2006.

2. Elrggal ME, Haseeb A, AlGethamy M, Ahsan U, Saleem Z, Althaqafi AS, et al. Dose optimization of
vancomycin in obese patients: A systematic review. Vol. 14, Frontiers in Pharmacology. Frontiers
Media SA; 2023.

3. Barras M, Legg A. Drug dosing in obese adults. Aust Prescr. 2017 Oct 1;40(5):189–93.