Patient & renal labs START HERE
yr
for Cockcroft-Gault
mg/L
auto-selects by BMI

Special populations

Lee-Dang active: SCr floored at 1.0, then 2.3 × CLM0.7. Cystatin C preferred if available.

Enter values and hit Calculate — results appear here.
Real-world vancomycin tools REDOSE PLANNER

Use when the patient is already on therapy and the next step depends on a real level: holding, giving a supplemental dose, solving level/time math, or correcting an early/late trough.

PK assumptionsShared by tools below
yr
kg
editable
L
enter Ke or CrCl
hr-1
enter CrCl or Ke
mL/min
Vd is estimated from age and weight when both are entered. Enter Ke or CrCl; the other field is auto-derived from Vd and the selected CLv model and remains editable.
Hold & exposure projectionNo additional doses
mcg/mL
Redose projectionDose now, then project
mcg/mL
min
auto from dose; editable
Level / time solverFirst-order equation
mcg/mL
mcg/mL
hr
Early or late trough correctionEstimate scheduled trough
mcg/mL
hr
Equations & assumptions
Hold & exposure projection

No additional dose is entered. The measured level is projected forward with first-order elimination.

C(t)=C0e-Ket AUC(a-b)=C0/Ke × (e-Kea - e-Keb)
Redose projection

The new dose is modeled as an infusion, not an instant bolus. The starting level decays during the infusion while the dose enters, so the displayed peak is the end-infusion level.

During infusion: C(t)=C0e-Ket + Dose/(KeVdTinf) × (1-e-Ket) After infusion: C(t)=Cende-Ke(t-Tinf)

AUC 0-24 starts at dose time. This can differ from bolus-style calculators that add Dose/Vd instantly.

Level / time solver

Use only when both levels are in the elimination phase and no dose occurred between them.

Clow=Chigh × e-Ket Ke=ln(Chigh/Clow)/t t=ln(Chigh/Clow)/Ke
Early or late trough correction

Corrects a measured level to the scheduled trough time using the shared Ke. It assumes no dose was given between the scheduled trough and the measured level.

Early draw: Cscheduled=Cmeasured × e-Ket Late draw: Cscheduled=Cmeasured / e-Ket
Learn METHODS & TIPS
Trough and AUC. A normal-looking trough can occur while AUC24 is above range. Dose to AUC, not trough.
Vancomycin Bedside Decision GuideWork the case in order: facts first, MRSA likelihood second, drug choice last.
SourceSource drives the drug: lung, blood, skin, bone, device, unknown.
SeverityShock, bacteremia, deep focus, or immunocompromise supports empiric coverage.
MRSA SignalPrior MRSA, positive nares, purulence, injection drug use, colonization.
ClockAt 48-72 h, negative cultures should force a stop-or-narrow decision.
1MRSA status: prove it or reassess fastStart
Proven MRSAUse vanco for serious infection. Target AUC24 400-600.
Not provenCover only if source + severity + risk make MRSA likely.
2Source fit: where MRSA coverage helpsSort
Purulent SSTIAbscess or drainage: drain first. Add MRSA coverage when systemic signs, failed drainage alone, recurrent disease, or high-risk host.
Nonpurulent cellulitisUsually strep. Use cephalexin/cefazolin-type coverage unless MRSA risk, toxicity, or beta-lactam failure.
PneumoniaNegative MRSA nares has high rule-out value for MRSA pneumonia. Stop MRSA coverage if cultures stay negative and patient is improving.
Blood/endocarditisTreat as high stakes. Repeat blood cultures, verify source control, and do not use nares to rule out.
3De-escalation: what to do todayNarrow
Stop MRSANo MRSA culture signal at 48-72 h, or pneumonia nares/cultures negative.
MSSASwitch off vanco. Use cefazolin, nafcillin, or oxacillin when possible.
4Alternatives: choose by source and jobOptions
Daptomycinbloodstream, not lungUse: MRSA bacteremia or right-sided endocarditis.Avoid: pneumonia or suspected lung-source sepsis.Monitor: baseline + weekly CPK; more often with renal impairment, statins, symptoms, or rising CPK.Act: stop for muscle symptoms with CPK >1,000 U/L (~5x ULN), or asymptomatic CPK >2,000 U/L (~10x ULN).
Linezolidlung / oral step-downUse: MRSA pneumonia, excellent oral bioavailability.Check: CBC if >7-10 days; platelet trend.Interactions: SSRI/SNRI, MAOI, methylene blue, serotonergic opioids. Do risk/benefit + monitoring, not reflex avoidance.
CeftarolineMRSA beta-lactamUse: labeled SSTI; useful MRSA beta-lactam option.Escalate: bacteremia/salvage should be ID/formulary directed.
Ceftobiprolenew S. aureus bacteremia optionUse: adult S. aureus bloodstream infection, including right-sided endocarditis.Pneumonia: community-acquired bacterial pneumonia labeling covers MSSA, not MRSA.Avoid: ventilator-associated bacterial pneumonia use; label warns of increased mortality in that unapproved setting.
Dalba / Oritalong-actingUse: selected SSTI or supervised outpatient completion.Avoid: unsettled source control, bacteremia/endocarditis, pneumonia, osteomyelitis unless specialist-directed.
De-escalateno MRSAMSSA: cefazolin, nafcillin, oxacillin.Enterococcus: ampicillin if susceptible.Otherwise: narrow to source and cultures.
5Reaction triage: rate reaction vs allergyTriage
Infusion reactionFlushing/itching during infusion. Stop, treat symptoms, then restart more slowly. Extend infusion time for future doses; consider diphenhydramine 30-60 min before the dose if clinically appropriate.
True allergy concernAirway swelling, bronchospasm, anaphylaxis, rate-unrelated hives, severe delayed rash. Use alternative; involve allergy/ID if vanco essential.
Daily checkpoint: organism, source, source control, cultures, susceptibilities, renal trend, stop date.
References
  1. ASHP/IDSA vancomycin monitoring guideline
  2. IDSA skin and soft-tissue infection guideline
  3. IDSA MRSA infection guideline
  4. ATS/IDSA HAP/VAP guideline
  5. ATS/IDSA community-acquired pneumonia guideline
  6. UCSF vancomycin infusion reaction guidance
  7. Vancomycin prescribing information
  8. Daptomycin prescribing information
  9. Linezolid prescribing information
  10. Ceftaroline prescribing information
  11. Ceftobiprole prescribing information
  12. Dalbavancin prescribing information
  13. Oritavancin prescribing information
Target & regimen AUC-GUIDED
Clearance source: none yet — run the Renal tab, or enter CL manually below
yr
actual body weight
from renal driver · mL/min
mL/min
target mg·h/L
mg·h/L
mg/kg
population clearance
0.75 × CrCl + 4 (ml/min)
volume of distribution
0.29×age + 0.33×wt + 11 (L)

CLᵥ and Vd are paired by source to preserve the assumptions of the published method.

Enter values and hit Calculate — results appear here.
Current regimen & level SS TROUGH
per dose
dosing frequency
per dose
min
steady-state Css
mcg/mL
yr
target mg·h/L
mg·h/L
actual body weight
population volume
0.29×age + 0.33×wt + 11 (L)
Level timing
Last dose given
:
Trough drawn
:
Next dose due
:
Enter values and hit Calculate — results appear here.
Regimen & two levels TWO LEVELS
per dose
dosing frequency
per dose
min
post-distribution
mcg/mL
end of interval
mcg/mL
Level timing
Dose start
:
Peak drawn
:
Trough drawn
:
Dosing state
Enter values and hit Calculate — results appear here.

Scope: stable, non-dialysis renal function. Recommendations utilize published First-order one-compartment estimates — verify against institutional protocol and clinical context. AUC24 400–600 for serious MRSA; sustained >650 raises nephrotoxicity risk. Population CLv models were derived from Cockcroft-Gault CrCl; eGFR drivers are de-indexed to BSA and run off-calibration.
TheraCALC — for use by licensed clinicians. Recommendations are generated using the proprietary TheraIQ engine developed and maintained in-house.

v2.241  ·  2026-10-13