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Therapy
T1. Antibiotic Therapy
T1.1. In case of Oxacillin resistance (substance selection)
T1.1.1. Vancomycin i.v.
Loading dose 25-30 mg/kg body weight (use of actual body weight)
Target level 15–20 mg/l or with continuous infusion 20-25 mg/l
Blood sampling for therapeutic drug monitoring before next administration or before dialysis
GFR >50 Maintenance dose depending on trough level 15-20mg/kg every 8-12h or as a continuous infusion
GFR 30-50
GFR <30
CHD 1 g after dialysis or depending on concentration
CVVH according to level

CAVE:
Nephrotoxicity
Adjustment to kidney function required.
Explanatory Notes:
Disadvantage: Nephrotoxicity, therapeutic drug monitoring required.
Abbreviations:
CHD Chronic hemodialysis
CVVH Continuous venovenous hemofiltration