Vancomycin

Desensitization
Protocol @dr.fathimashameen

Premedication: Diphenhydramine 50 mg IV and

hydrocortisone 100 mg IV 15 minutes prior to
initiation of protocol, then every six hours
throughout protocol

Vancomy
Infusi Conc
Dilution cin Dose
on No. (mg/ml)
(mg)

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
@dr.fathimashameen

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 Protocol
for Vancomycin
@dr.fathimashameen

1. Start at 0.5 mL/minute (30 mL/hour).

2. Increase by 0.5 mL/min (30 mL/hour)
every five minutes.
3. Max out at 5 mL/minute (300 mL/hour) if
tolerated.
4. If pruritus, hypotension, rash, or
breathing difficulties occur, pause the
infusion.
5. Resume at the highest tolerated rate.
6. This step can be repeated up to three
times for the same concentration.
7. After the fifth infusion, give the required
vancomycin dose in NS or D5W over two
hours.
8. Adjust the rate based on patient
tolerance.
9. Administer 50 mg of diphenhydramine
orally 60 minutes before each dose
 Reference
@dr.fathimashameen

Peter F Weller, MD,:N Franklin Adkinson, Jr,

MD.Vancomycin hypersensitivity.UpToDate.com

Wazny LD, et al. Desensitization protocols for

vancomycin hypersensitivity. The Annals of
Pharmacotherapy 2001; 35:1458. Copyright ©
2001 Harvey Whitney.

@dr.fathimashameen

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