<p>Concentrations of no more than 5 mg/ml and rates of no more than 10 mg/min are recommended in adults. In selected patients in need of fluid restriction, a concentration up to 10 mg/ml may be used.<br />
<br />
<strong>Patients with Normal Renal Function</strong>:</p>

<ul>
	<li><strong>Adults</strong>: Usual daily dose is 2 gm (in 4 or 2 divided doses).</li>
	<li><strong>Children</strong>: Total daily dose is 40 mg/Kg (in 4 divided doses).</li>
	<li><strong>Infants and Neonates</strong>: An initial dose of 15 mg/Kg is suggested followed by 10 mg/Kg every 12 hours in the first week, then every 8 hours up to 1 month.</li>
</ul>

<p><strong>Patients with Impaired Renal Function and Elderly Patients</strong>: Dosage adjustment must be made in patients with impaired renal function. In premature infants and the elderly, dosage reduction may be necessary to a greater extent than expected because of decreasing renal function.&nbsp; If creatinine clearance can be measured or estimated accurately, the dosage for most patients with renal impairment can be calculated using the following chart-</p>

<ul>
	<li>CrCl 100 ml/min: Vancomycin Dose 1545 mg/24 h</li>
	<li>CrCl 90 ml/min:&nbsp;Vancomycin Dose 1390 mg/24 h</li>
	<li>CrCl 80 ml/min:&nbsp;Vancomycin Dose&nbsp;1235 mg/24 h</li>
	<li>CrCl 70 ml/min:&nbsp;Vancomycin Dose&nbsp;1080 mg/24 h</li>
	<li>CrCl 60 ml/min:&nbsp;Vancomycin Dose&nbsp;925 mg/24 h</li>
	<li>CrCl 50 ml/min:&nbsp;Vancomycin Dose&nbsp;770 mg/24 h</li>
	<li>CrCl 40 ml/min:&nbsp;Vancomycin Dose&nbsp;620 mg/24 h</li>
	<li>CrCl 30 ml/min:&nbsp;Vancomycin Dose&nbsp;465 mg/24 h</li>
	<li>CrCl 20 ml/min:&nbsp;Vancomycin Dose&nbsp;310 mg/24 h</li>
	<li>CrCl 10 ml/min:&nbsp;Vancomycin Dose 155 mg/24 h</li>
</ul>

<p>The initial dose should be not less than 15 mg/kg even in patients with mild to moderate renal insufficiency. Above chart is not valid for functionally anephric patients. For such patients, an initial dose of 15 mg/kg of body weight should be given in order to achieve prompt therapeutic serum concentrations. The dose required to maintain stable concentrations is 1.9 mg/kg/24 h. Since individual maintenance doses of 250-1,000 mg are convenient, 1 dose may be given every several days rather than on a daily basis in patients with marked renal impairment. In anuria, a dose of 1000 mg every 7-10 days has been recommended. Intermittent infusion is the recommended method of administration. Intraperitoneal administration is not recommended.</p>