Procedure Logs

C3.1 R4(e): Perform & document a vancomycin pharmacokinetic interpretation

LM is a 33 week + 6 day (day of life: 21) neonate in for prematurity. LM’s current weight is 1.477 kg (up from a birth weight of 1.270 kg). During his stay a concern of sepsis/meningitis arose (=increasing bradycardia and desaturation episodes, elevated temperature = 37.9), resulting in vancomycin and cefotaxime being started empirically, blood cultures were taken and vancomycin levels were taken around the 9th dose.

The plan was to continue the vancomycin and cefotaxime for 5 days. Vancomycin dose is 18 mg IV Q8H (=12 mg/kg/dose) which is appropriate empirically based on the FH neonatal PDTM dosing guidelines for vancomycin (based on GA and day of life).

  • A trough level taken at 11:22 (next dose at 12:00) = 7.5 mg/L [aim for 5-15 mg/L in uncomplicated infections]

Based on this I wrote the following note in the chart:

Clinical Pharmacist Note re: vancomycin levels:

Patient is receiving empiric vancomycin + cefotaxime for ?sepsis/meningitis. vancomycin 18 mg (=12 mg/kg/dose) IV Q8H (next dose at 12:00).

  • Level taken around the 9th dose @ 11:22 = 7.5 mg/L [aim for 5-15mg/L in uncomplicated infections]
  • SCr < 27, Urine output ~ 3.5 ml/kg/hour

As the patient’s level and renal function within normal range, no recommendation to alter regimen at this time. No further levels needed.

– Iona Berger, Pharmacy Resident

This was my first vanco level to assess as a resident (I had one during my OEE rotation). It was a good exercise to assess the differences in gentamicin and vancomycin with regards to pharmacokinetics and why we usually only do a trough level in vancomycin.


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