A 60-year-old female patient with a vancomycin trough of 8 mg/L (target 10-15 mg/L for pneumonia) is currently receiving vancomycin 1 g IV every 12 hours. Her CrCl is estimated at 70 mL/min. The physician asks for a dose adjustment to achieve the target trough. What is the most appropriate recommendation?

Question: A 60-year-old female patient with a vancomycin trough of 8 mg/L (target 10-15 mg/L for pneumonia) is currently receiving vancomycin 1 g IV every 12 hours. Her CrCl is estimated at 70 mL/min. The physician asks for a dose adjustment to achieve the target trough. What is the most appropriate recommendation?

Answer options:

• Increase vancomycin to 1.25 g IV every 12 hours.
• Increase vancomycin to 1 g IV every 8 hours. ✅ Increase vancomycin to 1.5 g IV every 12 hours.
• Decrease the interval to every 8 hours and maintain the 1 g dose.

Correct answer: Increase vancomycin to 1.5 g IV every 12 hours.

Explanation: To increase the trough level without drastically altering the interval for a normal-to-mildly impaired renal function, increasing the dose is generally preferred. A direct proportional increase is often used as a starting point; if 1 g yields 8 mg/L, to reach 10-15 mg/L, increasing to 1.25 g to 1.875 g would be appropriate. 1.5 g q12h is a reasonable and practical option to achieve the target trough given the current trough of 8 mg/L and a CrCl of 70 mL/min.