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Vancomycin as a single daily dose in critically ill patients on an intensive care unit

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The purpose of the study was to assess the peak and trough levels of 2 g of vancomycin (VAN), given once daily (od), in critically ill patients, irrespective of renal function, instead of lg VAN twice daily.


Prospective, observational, open study. 2 g of VAN, diluted in 500 mls of 0.9% normal saline, infused over four hours. VAN blood-level assays were done at 1, 2 and 12 h after completion of the infusion, and 12 hourly thereafter or until the next dose of VAN. (Random VAN levels are done routinely on the ICU at 08h00 daily.) Another dose of VAN was given if the random level was below 10 mg/l.


Five subjects (2 male, 3 female) aged 16–64 (mean 56 ± 23.5) years, weighing 65–105 (83 ± 21.4) kg were enrolled. The assay used to measure VAN levels was the FPIA using the FLX system. The peak levels 1 and 2 h after the infusion were between 21.5–50.6 (35.6 ± 12.9 mg/l) and 20.4–48 mg/l respectively.


Our peak levels did not exceed 80 mg/l, a level which has been associated with ototoxicity. The incidence of nephrotoxicity with VAN alone is about 5% and is unrelated to serum VAN concentrations. We did not assess the effect on renal function, since most of our patients requiring VAN were already on continuous renal replacement therapy.

Concerns have been voiced regarding the short post-antibiotic effect (PAE) of VAN (<2 h). In aminoglycides the larger, od dose resulted in a prolonged PAE. The PAE of once daily VAN is unknown and at present we are maintaining trough levels above 10 mg/l.

Our results show that od VAN 2 g should not cause an increase in ototoxicity as peak VAN levels are well below 80 mg/l and if trough levels are maintained above the minimum inhibitory concentration of the organism, then concerns regarding the short PAE are eliminated.

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Grundler, S., Stallard, N., Paull, A. et al. Vancomycin as a single daily dose in critically ill patients on an intensive care unit. Crit Care 4 (Suppl 1), P90 (2000).

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