Maximum dose of vancomycin in Pediatrics

Use the following table to guide monitoring of vancomycin based on the patient's clinical status: 2. Dose should not exceed 100 mg/kg/day at any point in therapy. 3. Consider ID consult in patients with confirmed MRSA infection who do not improve on vancomycin. ID consult should be ordered for all patients with MRSA bacteremia For children one month to six years of age the suggested empiric vancomycin pediatric dose is 40 mg/kg/day divided into four doses given every six hours. [5] For those aged seven to 18 years old the recommended vancomycin pediatric dose is 40 mg/kg/day divided into three doses given every eight hours

Quick summary of pediatric vancomycin CPA • Children >=30 days generally require 60 mg/kg/day to achieve AUC 24 target between 400 and 750 • Max dose 3-4.5 g/day • Delaying TDM in children with normal renal function for up to 72 hours is safe and prevents unnecessary work • ~90% of patients receive 72 hours or less of dru Usual Pediatric Dose for Pseudomembranous Colitis. Oral solution: Less than 18 years: 40 mg/kg orally in 3 to 4 divided doses-Maximum dose: 2 g/day-Duration of therapy: 7 to 10 days Comments:-Safety and efficacy of capsule formulations have not been established in patients younger than 18 years of age.-Parenteral formulations will not treat colitis

o Max starting dose= 1 gram every 6 hours Adjust interval to every 8 or 12 hours for impaired renal function (CrCl <50 mL/min) UHS Pediatric Vancomycin Dosing Last Updated: June 201 Initial dose: The recommended starting dose for vancomycin infusions is 60mg/kg/day (to a maximum of 3 grams over 24 hours). Higher doses may be considered in consultation with Infectious Diseases. Surgical prophylaxis: Single dose 15mg/kg/dose (to a maximum of 750mg) via slow infusion (see administration section for further information) Maximum empiric daily dose: 3600 mg, although most children won't need more than 3000 mg/day Monitoring: AUC-guided monitoring is recommended and may begin as early as 24-48 hours into vancomycin therapy

Indicated for treatment of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis in combination with rifampin and an aminoglycoside. Usual dosage: 2 g divided either as 500.. First infection: 40 mg/kg/day PO in 4 doses for 10 days (Max: 125 mg/dose for non-severe infections and 500 mg/dose for severe infections). Can also use similarly for staphylococcal enterocolitis. Recurrent infection: 40 mg/kg/day PO in 4 divided doses for 10-14 days, then 20 mg/kg/day PO 12 hourly for 7 days, then 10 mg/kg PO once a day for 7 days, then 10 mg/kg PO every 2nd-3rd day for 2-8 weeks The guidelines proposed that patients with mild/moderate infections receive 15 mg/kg per dose every 6 hours (maximum: 750 mg/dose) and those with severe infections, including MRSA, receive 20 mg/kg per dose every 6 hours (maximum: 750 mg/dose). Goal troughs remained the same as detailed in phase 1

Maintenance dose (MD): 15 to 20 mg/kg/dose every 6 hours to be given as IV infusion over 2 hours (based on type of infection). Adjust subsequent dose to achieve a target AUC/MIC >400. In institution in which AUC calculation is not feasible, trough concentration 10 t 15 mg/ml for mild infection and 15 to 20 mg/ml for severe infection ADULT INTRAVENOUS VANCOMYCIN DOSING AND MONITORING GUIDELINES DOSE: Adult dose: (based on actual body weight (ABW))*,^: 12.5 to 15 mg/kg (round off to nearest 250 mg increment, to max dose of 1500mg; see dosing table) * If ABW is > 30% ideal body weight (IBW), then use adjusted body weight = IBW + 0.4(Total body weight - IBW VANCOMYCIN - PEDIATRIC PATIENTS Concentration at the end of the dosing interval just before the next dose (within ~ 30-min of next dose). Vd or Volume of Distribution1 The volume of distribution is the size of the compartment necessary to account for the total drug amount in th In pediatric patients, there is insufficient data to base a loading dose recommendation in normal-weight patients. Interestingly, the vancomycin dosing guidelines state that in obese pediatric patients, a loading dose of 20mg/kg may be considered (assuming normal renal function)

Adjusted dose (mg/day) = last maintenance dose (mg/day) x (target level/last vancomycin level) Eg if a 3 kg infant is prescribed 50 mg/kg/day and has a vancomycin level of 13 mg/L, the adjusted dose = 150 mg x (20/13) = 230 mg/day . Intermittent dosing. Neonates: 15 mg/kg/dose intravenously (IV) at a frequency according to the table below Based on current guidelines, in pediatric patients with normal renal function, defined as Glomerular Filtration Rate (GFR) > 60 mL/min, the recommended dose of vancomycin is 40-60 mg/kg/day (5, 6). We undertook this descriptive prospective study to evaluate vancomycin dosing regimen and associated serum concentration i New vancomycin dose: [target level]/[actual level] x dose = 18/12 x 1000mg = 1500mg 12-hourly Additional Advice & Support The Infectious Diseases team is available to provide advice on dosing and monitoring of vancomycin therapy fo Adult: 15-20 mg/kg 8-12 hourly via slow infusion over 60 minutes at Max rate of 10 mg/min. Max: 2,000 mg daily.Loading dose for severe cases: 25-50 mg/kg. Doses are adjusted according to plasma-concentration monitoring. Duration of treatment is based on the severity of infection and individual clinical response, refer to detailed product guideline

Vancomycin IV Dosing in Pediatrics • DoseMeR

Each dose should be administered at no more than 10 mg/min, or over a period of at least 60 minutes, whichever is longer. Other patient factors, such as age or obesity, may call for modification of the usual daily dose. Pediatric Patients: The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every six hours 15-20 mg/kg every 8-12 hours (max. per dose 2 g) adjusted according to plasma-concentration monitoring, duration should be tailored to type and severity of infection and the individual clinical response—consult product literature for further information, in seriously ill patients, a loading dose of 25-30 mg/kg (usual max. 2 g) can be used to facilitate rapid attainment of the target trough serum-vancomycin concentration INTRODUCTION. Vancomycin is a glycopeptide antibiotic administered intravenously for treatment of patients with suspected or proven invasive gram-positive infections, including methicillin-resistant Staphylococcus aureus (MRSA).. Appropriate dosing and administration of vancomycin requires consideration of the pathogen and its susceptibility, type and severity of infection, patient weight, and. Vancomycin dosing and monitoring in Neonates and Pediatrics . Vancomycin is a glycopeptide antibiotic that has activity against gram-positive organisms, including MRSA and Enterococcus. It has activity against MSSA, although it is inferior to the penicillinase-resistant penicillins (eg, oxacillin). Dosing of vancomycin: a. Neonatal Dose Pediatric Antimicrobial Renal Dosing Guidelines Vancomycin Indication Estimated Creatinine Clearance (mL/min) >50 30-50 10-29 <10 and Hemodialysis CRRT 2 FT Neonate- 1 month of ag

Vancomycin Dosage Guide + Max Dose, Adjustments - Drugs

  1. g (Adults, NEONATES, AND Pediatrics): o Ti
  2. e the relationship between the initial dose used and the resultant trough. Over a 4-year period (2010 to 2013), patients who were 1 month to 18 years old, admitted to the pediatric floors or the PICU, treated with at least 3 similar and uninterrupted doses of vancomycin
  3. • Consider alternate sources of vancomycin that may be contributing to measured serum concentrations (e.g., vancomycin instille d intra-operatively, or added to cement during orthopedic surgery) • If the trough is below the target level, ensure the dose is 15-20 mg per kg actual body weight, and conside
  4. Eight of the 12 respondents reported that their hospitals did not have a maximum initial dose. Among the remaining hospitals, the maximum dose was 60 mg/kg per day at 3 centres and 100 mg/kg per day at 1 centre. Table 1 Initial Vancomycin Dosages and Intervals Used for Pediatric Care in Canad
  5. Using quality improvement methodology with standardized higher initial vancomycin doses, we demonstrated improved adherence to national trough guidelines without noted safety detriment Miloslavsky et al (2017). Abstract: BACKGROUND AND OBJECTIVES: There are limited data guiding vancomycin dosing practices in the pediatric population to target the goal troughs recommended by national.
  6. utes up to 12 mg/dose every 1-2
  7. Treatment of CVC infections in pediatric patients should be guided by the Pediatric Infectious Diseases Consult Service. and a maximum of 24 hours for non-hemodialysis patients, and a maximum of 3 days for hemodialysis patients. Vancomycin 5 Heparin 1,000 units/mL 0.9 NaC

New 2020 Vancomycin Dosing Guidelines: What Pharmacists

Oral Cefixime 20 mg/kg/day (max dose of 1200) for 14 days or azithromycin 10-20 mg/kg (ceiling dose of 1 gm) for 7-10 days. Antibiotic therapy should be continued till one week post-fever defervescence. (b) For inpatients. Inj Ceftriaxone 100 mg/ kg/day and shift to oral cefixime once fever resolves The prevalence of pediatric obesity has increased over the past 3 decades, reaching 17% among children 2 to 19 years in 2011-2014. 1,2 Most medications in pediatrics use weight-based dosing, typically by using total body weight (TBW). 3 For children with obesity, compared with a child with normal weight (NW), this practice results in a higher dose for a given clinical presentation

The exact time that a dose of vancomycin is administered should also be recorded. For patients with CrCl≥30mls/min the next (fourth) dose should be given and the result used to change further doses if necessary. The target range for vancomycin pre-dose concentrations in ALL patients on intermittent vancomycin in SRCO is 15-20mg/L o Vancomycin (see Vancomycin IV Order Set in Cerner for dosing o Clindamycin 10 mg/kg/dose PO q8h (max 450 mg PO q8h) OR o Doxycycline 2.2 mg/kg/dose PO q12h (max 100 mg PO q12h) (only for ≥ 8 years General pediatric surgery should be consulted for potential debridement. Treat wit

This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee PEDIATRIC ANTIBIOTIC PROPHYLAXIS FOR SURGICAL PROCEDURES PEDIATRIC DOSING GUIDE Intra-operative re-dosing interval for prolonged procedures or major blood loss (>20 mL/kg) NEONATAL SECTION First 4 weeks of life or PMA* 44 weeks Antibiotic IV Dose Maximum Dose Normal Renal Function Compromised Renal Function (CrCl <30 mL/min) Neonatal IV Dose Maximum Recommended Dosage of Local Anesthetic Agents

Vancocin (vancomycin) dosing, indications, interactions

Linezolid (10 mg/kg/dose, maximum dose of 600 mg/dose) or vancomycin 26,29 and piperacillin-tazobactam or a fourth-generation cephalosporin for drug-resistant gram-negative organisms along with clindamycin are recommended until susceptibilities result. 26 Typical therapy duration is 10-14 days. IVIG (1-2 g/kg/day given once) has been suggested. this dose. A maximum daily dose of 10 mg is recommended by the manufacturer. 1,2 Based on the studies available to da te, amlodipine should be initiated in children at a dose of 0.05 to 0.1 mg/kg/day given once daily. The dose may be increased as needed to achieve blood pressure control. In most of the pediatric Drug Conc. Neonatal Dose Pediatric Dose Azithromycin (Zithromax®, Zisrocin®) Susp. 200 mg /5mL Treatment and prophylaxis of pertussis infections : 10 mg /kg/dose once daily for 5 days Infants 1-5 months: 10 mg /kg once daily for 5 days. Children ≥6 months: Three-day regimen: 10 mg/kg (maximum dose Dose: 15 mg/kg/dose IV x1; Start: complete infusion 1h prior to surgery *PID, mild-mod. severe [adolescents] Dose: 500 mg PO q12h x14 days; Info: part of multi-drug regimen, or in combo w/ azithromycin *bacterial vaginosis [treatment, preadolescents 45 kg] Dose: 15 mg/kg/day PO divided q12h x7 days; Max: 1 g/da

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Video: Vancomycin - Pediatric Oncal

Our research is to establish population PK model utilizing the clinical data of pediatric patients from a prospective, pathogen diagnosis-based, multicenter, observational study (Liang et al., 2018; Shen et al., 2018), assess the clinical and microbiological efficacy of vancomycin, and recommend optimized dose regimen of vancomycin in Chinese. o Gentamicin: only a single dose per 24-hour period should be given. Use ideal body weight to calculate dose. Seek Infectious Diseases (ID) team/Pharmacy advice about re-dosing and therapeutic drug monitoring. o Vancomycin: only a single dose of 15 mg/kg (maximum 500mg) is sufficient to cover procedures up to 6 hours Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose) AND Vancomycin: Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) Use Adjusted Body Weight for patients >120% of Ideal Body Weight. Recommend loading dose (20-25 mg/kg IV x1) for serious infections including CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis. Use Vancomycin Dosing Calculator (Excel file) for more precise dose calculation and level-based adjustment

The Impact of Pediatric-Specific Vancomycin Dosing

Each dose should be administered at no more than 10 mg/min, or over a period of at least 60 minutes, whichever is longer. Other patient factors, such as age or obesity, may call for modification of the usual daily dose. Pediatric Patients: The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every six hours. Each dose should be. Each dose should be administered at no more than 10 mg/min, or over a period of at least 60 minutes, whichever is longer. Other patient factors, such as age or obesity, may call for modification of the usual daily dose. Pediatric Patients: The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every six hours Vancomycin 10 mg/kg/dose PO q6h (max 500 mg/dose) +/- Metronidazole 10mg/kg/dose IV q8h (max 500 mg/dose)2 FULMINANT: Vancomycin 10 mg/kg/dose PO q6h (max 500 mg/dose) - If ileus present: Add rectal vancomycin as retention enema q6h3 PLUS Metronidazole 10 mg/kg/dose IV q8h (max 500 mg/dose)2 2ND OR SUBSEQUENT RECURRENCE: Vancomycin taper and.

Vancomycin is one of the most studied antibiotics used in the treatment of PSC with promising results. There is not currently sufficient evidence to support treatment recommendations. Further research is needed to establish if vancomycin is a PSC treatment After dilution in 5% or 10% D/W (saline solution should not be used), infusion of a test dose of 0.1 mg/kg (maximum 1 mg) over 1 hour to assess patient's febrile and hemodynamic response;* if no serious adverse effects are observed, infusion of a therapeutic dose (usually 0.25-1.5 mg/kg over 2-6 hours), which may be given the same day as.

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Vancomycin Dosing Guidelines What You Need To Know

TDM after the first dose of antibiotic was adopted in our institution. This study aims to evaluate if target therapeutic drug concentrations could be achieved more rapidly in patients with TDM performed after the first dose of gentamicin, amikacin, or vancomycin compared to TDM at steady state Tellingly, Lee says, the higher the dose, the greater the risk, with each 5 milligrams per kilogram increase boosting the risk of kidney failure by 16 percent. In other words, a 20 kilogram (44-pound) child receiving 1,600 milligrams of vancomycin per day has a 16 percent higher risk for kidney damage than a child of the same age and weight. Vancomycin (Vancocin ® 500 mg vial, Eli Lilly, Cairo, Egypt) was administered via slow intermittent intravenous infusions over 30 min. All patients received a fixed dose of vancomycin of 15 mg/kg every 6 h with maximum dose of 500 mg every 6 h according to the hospital protocol Add up total dose of vancomycin and reduce by 10-20% Round to nearest 250 mg This will be the recommended starting dose for CI vancomycin o If patient supra- or sub-therapeutic on intermittent therapy: Estimate intermittent dose needed to make therapeutic and reduce by 10-20% Round to nearest 250 m For the treatment of meningitis in children 1 month of age or older, the AAP and other clinicians recommend that vancomycin be given in a dosage of 60 mg/kg daily (maximum 2 g daily) given in divided doses every 6 hours. For specific information on other pediatric dosage regimens, published protocols and specialized references should be consulted

A vancomycin dose of 25-30 mg/kg/dose every 12-24 hours with serum concentration monitoring is a reasonable empiric dosing strategy to obtain an area under the curve for 24 hours greater than 400 in pediatric extracorporeal membrane oxygenation patients. Pediatric Critical Care Medicine19 (10):973-980, October 2018 Pharmacokinetics and dose requirements of vancomycin in neonates C Grimsley, A H T Abstract Aims—To design and evaluate dosing guidelines for vancomycin based on data collected during routine use of the drug. Methods—Following the observation that 66% of neonatal vancomycin trough con-centrations were outside the target range Pregnancy Category B - The highest doses of vancomycin tested were not teratogenic in rats given up to 200 mg/kg/day IV (1180 mg/m 2 or 1 times the recommended maximum human dose based on body surface area) or in rabbits given up to 120 mg/kg/day IV (1320 mg/m 2 or 1.1 times the recommended maximum human dose based body surface area) The following table aims to target a vancomycin trough level of 5-15mg/L (for empirical therapy). Subsequent doses may be increased incrementally up to a maximum dose of 80mg/kg/day based on serum trough levels if clinically appropriate (e.g. absence of renal impairment or concomitant use of nephrotoxic medications)

Clinical Practice Guidelines : Vancomyci

Vd is the volume of distribution (in liters); dose is the vancomycin dose (in milligrams); T inf is the vancomycin infusion time (in hours); k is the elimination constant (Kel, in hr-1); C max is the true peak concentration; C min is the true trough concentration (if at steady state) or is 0 (zero) if not at steady stat 20 mg/kg IV loading dose, followed by 20 mg/kg/dose IV every 24 hours is recommended by the American Academy of Pediatrics (AAP).[63245] The FDA-approved dosage is 15 mg/kg/dose IV initially, then 10 mg/kg/dose IV every 12 hours for the first week of life, then increase to every 8 hours.[40937] The dosing interval of vancomycin may need to be extended in neonatal patients on ECMO; doses of 20. a Use Q8 hr dosing interval for older adolescent Clostridium difficile colitis (PR route of administration may be preferable for complete ileus): Child: 40-50 mg/kg/24 hr ÷ Q6 hr PO × 7-10 days Max dose: 500 mg/24 hr; higher maximum of 2 g/24 hr have also been used for severe/fulminant disease. Adult: 125 mg/dose PO Q6 hr × 7-10 days; dosages as high as 2 g/24 hr ÷ Q6-8 hr have.

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Vancomycin: Indication, Dosage, Side Effect, Precaution

A slow vancomycin bolus of 20 mg/kg, up to a maximum dose of 1000 mg was administered before skin incision and a further dose of 10 mg/kg (up to 500 mg) at CPB start. Vancomycin samples were collected intraoperatively at four time points 0.3 units/kg IV; (Maximum dose = 20 units). Start with 0.002-0.005 unit/kg/min IV initially; may be increased to 0.01 unit/kg/min IV as and when required. If bleeding has been controlled for 12-24 hours, taper off over 24-36 hours The patient's serum daptomycin concentration 30 minutes after the end of the infusion was 103.4 μg/mL, which was similar to the mean C max reported in adults receiving a dose of 6 mg/kg (93.9 μg/mL) and lower than the mean reported C max values after adults were administered an 8-mg/kg dose (123.3 μg/mL) or a 12-mg/kg dose (184 μg/mL). 8. Safety of Vancomycin Dosing and AUC-Guided Dose Adjustments in Pediatric Patients. At the completion of this activity, pharmacists will be able to: Describe appropriate vancomycin usage in pediatric patients Discuss the 2020 guideline for vancomycin treatment of methicillin resistant Staphylococcus aureus (MRSA) infections for pediatric patient 5 mg/kg/dose IV every 24 hours for up to 14 days. Daptomycin was shown to be efficacious, safe, and generally well tolerated compared with the standard of care (SOC; vancomycin, clindamycin) in pediatric patients with complicated skin and skin structure infections caused by gram-positive pathogens in a multicenter, randomized, clinical study (n = 396)

Therapeutic monitoring of vancomycin for serious

vancomycin dose of 20mg/kg intravenously over 2 hours (com - parison group). the initial dose was administered over 2 hours in both groups to preserve allocation concealment. All patients subse-quently received a 20mg/kg dose every 8 hours as was the stand - ard of care in our hospital for treatment of severe infections at the time of the study Use this formulation of Vancomycin Injection only in pediatric patients (1 month and older) who require the entire dose (500 mg, 750 mg, 1 g, 1.25 g, 1.5 g, 1.75 g or 2 g) of this single-dose flexible bag and not any fraction of it [see Dosage Forms and Strengths (3)] To our best knowledge, the pediatric pharmacokinetics of vancomycin has not been described before in such a large and rich dataset, with a broad range and overlay of multiple relevant covariates such as age, body weight, and renal function and where the vancomycin samples showed a good distribution in time after dose, especially over the first. - 10mg/kg/dose (to a maximum of 125mg) 12 hourly for 7 days then; - 10mg/kg/dose (to a maximum of 125mg) every second day for two to eight weeks. DOSAGE ADJUSTMENT As oral absorption of vancomycin is negligible, dose adjustment for oral administration is not required. Refer to the intravenous vancomycin monograph for dosag Vancomycin oral (10 mg/kg/dose four times a day; maximum 125 mg/dose) for 10 to 14 days. Treatment: Severe CDI (score 5 or more) • Vancomycin oral (10 mg/kg/dose every 6 hourly; maximum 500 mg/dose) for 10 days. (Vancomycin serum trough levels should be monitored if maximum dose of 40 mg/kg/day; up to maximum 2 g/day orally is given).

Population pharmacokinetic analysis of vancomycin in

Daily Maximum Dose Additional Comments PO max. IV max. C Amikacin 1 month to 18 years: 15mg/kg/dose given 24-hourly 15 mg/kg/day IV given once daily 1.5 g/day E Amoxicillin 1 month to 18 years, PO: 15-30mg/kg/dose given three times daily (max 500mg/dose) 1 month to 18 years, IV: 30-60mg/kg/dose given 8-hourl The majority of patients (81.3%) received vancomycin for 3 days or less (as per our institutional protocol). A median 0% (IQR 0-100%) of doses of vancomycin were administered in the pediatric intensive care unit or cardiac intensive care unit, reflecting that the majority of vancomycin doses were administered outside of the intensive care unit

Dose Optimization of Vancomycin Using a Mechanism-based

Vancomycin inhibits transpeptidation by binding to D-alanyl-D-alanine residues of the bacterial cell wall. Pharmacodynamics Vancomycin commonly thought of as a time-dependant killer (T>MIC), however additional data suggests may also follow AUC:MIC Pharmacokinetics: Cmax: 18-26mg/L (after 15mg/kg dose) Half-life: 3-11 hour The empiric protocol for all febrile neutropenic patients is monotherapy with piperacillin/ tazobactam (Tazocin) 100mg/kg q6h (combined product), max 4.5g per dose, and subject to the following exceptions: For patients who have been treated with high dose cytarabine (HD ARA C) or are on AML therapy, add vancomycin 15mg/kg q6h (initial max 1g.

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Vancomycin half-life, steady-state volume of distribution, and body clearance averaged 6.0 h, 0.53 liter/kg, and 1.22 ml/min after the first dose and only slight differences were observed in these parameter estimates under steady state conditions. However, substantial accumulation of vancomycin in serum was observed with multiple dosing 300 mg/kg per day IV divided every 6 or 8 hours (maximum dose 16 g/day of piperacillin component) MSSA. GAS. Oral anaerobes. Gram-negative organisms: Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene: Vancomycin: 45 to 60 ‡ mg/kg per day IV divided every 6 or 8 hours (maximum 4 g/day) MSSA. CA-MRSA. GA tively from routine clinical care of pediatric patients treated with intrave - nous vancomycin using the InsightRX precision dosing platform at the intensive care unit (ICU) of UCSF Benioff Children's Hospital between March 2018 and May 2020. These data described vancomycin dose ad The objective of this study was to check which initial dose of vancomycin is needed to achieve the therapeutic target that is currently used in pediatrics. The search was conducted in the following data sources: Pubmed (1980-2017), the Cochrane Library, and Embase (1986-2017) and the references of the published studies; searches were performed using the key terms: child, children. Pediatric: Metronidazole 30 mg/kg/day IV divided every 8 hours (maximum dose of 2 g/day) and Vancomycin 40 mg/kg/day oral solution2 PO divided every 6 hours (maximum dose of 2 g/day) Consider use of vancomycin retention enema dosed every 6 hours if patient not neutropenic 1-3 years: 250 mg in 50 mL NS 4-9 years: 375 mg in 75 mL N dose steroid group (median dosage: 2 mg/kg/day, <5 mg/kg/ day), and a high-dose steroid group (25 mg/kg/day, maximum dosage: 1 g/day for 3 days and 1 mg/kg/day thereafter). All pa-tients had normal kidney and liver function and underwent similar adjunctive treatments for the control of fever, seizures, and intracranial pressure