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Brand names: Vancocin • Drug class: Glycopeptide antibiotic
Vancomycin is a workhorse IV antibiotic for serious infections — and it's both cleared by and toxic to the kidneys. In CKD and dialysis, dosing is level-guided and AKI risk is real. The mantra: right dose, right interval, right monitoring.
Vancomycin is ~80-90% renally cleared. In renal impairment, the dosing interval lengthens dramatically (dose based on AUC/MIC targets). Vancomycin itself can cause AKI (especially combined with piperacillin-tazobactam or aminoglycosides), and trough/area-based monitoring is mandatory. Dialysis patients get vancomycin after sessions, with levels checked — because it's poorly removed by most dialyzers except high-flux ones.
Renal dosing tables by CrCl with AUC-based monitoring recommended
ASHP/IDSA Vancomycin Guideline, 2020
AKI risk increased with vancomycin + piperacillin-tazobactam combination
Multicenter cohort data, 2023
CrCl >50: standard intervals. CrCl 20-50: 15-20 mg/kg every 24-36h. CrCl <20: every 48h or longer. Dialysis: 15-20 mg/kg after each session. Always confirm with levels (trough or AUC-guided) — never fixed-dose without monitoring in renal impairment.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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