This article aims to identify and discuss free online vancomycin dosing calculators. Many people are interested in dosing and monitoring vancomycin, hopefully this article will assist in discussing some available resources.
Authored by: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID
The below article was released in 2022 and may be of interest to readers of this page:
[Last updated: 7 November 2018]
Vancomycin is an antibiotic that has utility versus infections occurring in many locations (e.g., skin and soft tissue, bone, heart, lung, blood) and has antibacterial activity against an array of clinically relevant Gram positive bacteria (e.g., Streptococci, Enterococci, Staphylococci). In the hospital setting intravenous vancomycin is frequently employed to provide broad Gram positive coverage, which includes methicillin-resistant Staphylococcus aureus (MRSA).
Once ordered, dosing and monitoring of intravenous vancomycin is often a challenge given that every patient case is unique and typically requires at least daily assessment of clinical factors. There are numerous questions that must be answered to guide reasonable decision making and there are frequently multiple courses of action that can be considered acceptable in the same clinical scenario. The goal with vancomycin is to give enough drug to treat the infection, while not giving too much drug to cause toxicity (typically concern is for nephrotoxicity).
Understanding pharmacokinetics and pharmacodynamics (Pk/Pd) is key for informed decision making and there are several approaches to dosing vancomycin. Some institutions have no local guidance and it is left to provider discretion, some use strict algorithms, some use loosely structured weight-based dosing, some employ AUC:MIC-based dosing (area under the curve: minimum inhibitory concentration), and others use a combination of these and/or other strategies. In addition, many hospitals now employ vancomycin pharmacy-to-dose programs. Through these programs the physician (a diagnostic expert) identifies the need for the antibiotic and the pharmacist (a drug expert) is empowered to change doses and order labs.
With the frequent need for therapeutic drug monitoring many people (including pharmacists, physicians, nurses, administrators, and lab staff) are interested in how to dose vancomycin safely, effectively, and efficiently.
In a recent AJHP article, Heil and colleagues detailed an outline for implementing AUC-based vancomycin dosing, which is anticipated to be an important component of the long-awaited update to the vancomycin dosing guideline published in January of 2009. This got me thinking about what online tools there are for dosing vancomycin in our current technologically advanced world.
After performing internet searches the following free online vancomycin dosing calculators were identified. A link to each is provided as is a brief description. Users are encouraged to explore each individually to gain a deeper understanding of what these tools have to offer. Readers are cautioned that inclusion within this list does not indicate the calculator will necessarily be accurate, updated, or ready for use in clinical practice. There is not a particular order in which the following are listed. “Last updated” refers to the last update I was able to identify at the time of writing this article. Additional resources of this nature may exist that are not listed, however they were not captured in my informal internet searches.
Learn Antibiotics
1. DoseMeRx Vancomycin Dosing Calculator (free version)
Link to calculator is here.
Owner: DoseMe Pty Ltd
Last updated: Not found, however this is a new calculator so assume October 2018
Description: This is a 3-step calculator (patient data, previous doses, concentrations). It does not allow for calculations outside of weight 40-200kg, height 151-210 cm, age 18-100 years, SCr 0.1-3 mg/dL, frequency Q12-Q48, doses given 0-5, or target trough of 15 mcg/mL. The calculator produces trough target-based, guideline-based, and label-based dosing reports. It includes an interactive color graph. It provides the option to have a free target trough report sent by email.
AUC output included: Yes
Impression: Neat simplified tool good for students learning about vancomycin Pk/Pd or professionals making basic calculations. Makes me curious about the full paid DoseMeRx tools, which offers much more functionality.
2. Vancomycin-Calculator.com
Link to basic & advanced calculators is here.
Owner: Nathan Fewel, Pharm.D., BCPS
Last updated: October 2018
Description: A basic and an advanced vancomycin dosing calculator are provided. Each tool has all data points on one webpage, allowing the user to enter values and select buttons like “calculate” to produce results. The basic tool allows for initial dosing calculations, dose adjustments by trough, and peak-related calculations. The advanced tool is much more in-depth and has tabs embedded into the webpage. The advanced tool allows the user to perform a variety of calculations, including for making decisions about loading doses, dialysis patients, AUC considerations, and more. The advanced tool’s initial dosing section provides a graphical output that can be easily manipulated as the inputs are modified. References and descriptions are provided.
AUC output included: Yes
Impression: Multifunctional tool that is easy to use and interpret. Could be useful for a range of individuals. I like the option to use the basic or advanced calculator as well as how inputs and calculation results are all easy to see on one webpage.
3. ClinCalc Vancomycin Dosing Calculator
Link to calculator is here.
Owner: ClinCalc LLC
Last updated: June 2015
Description: An advanced vancomycin dosing calculator is provided. The initial screen allows the user to enter patient parameters followed by elimination data (can be by empiric, one level, or two levels). The calculator outputs recommended dosing and pharmacokinetic parameters. An interactive color graph is provided. A basic progress note that can be copied and pasted is generated. References and explanations are provided.
AUC output included: Yes
Impression: Multifunctional tool that provides the user with lots of helpful information. Could be useful for a range of individuals. I would prefer to have it more condensed so a greater amount of data could be viewed on one webpage without scrolling so much. I like the graph it produces and the ability to pull data from the tool into a note template.
4. MedCalc Vancomycin Dosing Calculator
Link to calculator is here.
Owner: Individual or company not found
Last updated: January 2010
Description: This calculator expands as additional data is entered. The user is able to input patient data and perform an “initial” or “revised” dosing calculation. References and equations are provided, but are limited.
AUC output included: No
Impression: Neat basic tool, but last updated in 2010 and lacks descriptions or details found in other tools. I can see this possibly being useful for students, but not likely useful for practicing clinicians. Proceed with caution.
5. MPR Vancomycin Dosing Calculator
Link to calculator is here.
Owner: Haymarket Media, Inc
Last updated: February 2016
Description: Limited tool that allows the user to input patient characteristics of: sex, age, height, weight, Cmax, Cmin, obesity status, volume status, and ESRD status. Once all data points are filled in the calculator automatically generates results, including: dosing weight, creatinine clearance, elimination rate, dosing interval, volume of distribution, loading dose and maintenance dose. Requires user to scroll down webpage, provides a single reference, and does not provide any guidance or interpretation.
AUC output included: No
Impression: A very simple calculator that could be useful for students. Proceed with caution.
6. Surgical Critical Care Vancomycin Dosing Calculator
Link to calculator is here.
Owner: Michael L. Cheatham, MD, FACS, FCC
Last updated: Not found, could be as far back as 2008 which is the copyright indicated on the webpage
Description: A very simple calculator that allows the user to input the patient’s: age, weight, sex, and current serum creatinine. It then outputs: dosing weight, estimated creatinine clearance, loading dose, and maintenance dose. Details on vancomycin dosing are provided.
AUC output included: No
Impression: Very simple tool that could be useful for students. I like how all entered data and results are easily viewable on one screen.
7. Pharmacy Joe Vancomycin Dosing Calculators
Link to allometric vancomycin dosing calculator is here. Link to vancomycin AUC:MIC estimator is here.
Owner: RxJ Solutions, LLC
Last updated: Not found
Description: The allometric calculator is an extremely simple tool that allows the user to enter a patient’s weight in kilograms, then it generates a dose. The AUC:MIC estimator is more in-depth and allows the user to enter case-specific data, then an AUC:MIC estimate is generated. The link to evidence goes to a single reference for both tools.
AUC output included: No
Impression: Tools limited in functionality that may be useful for people focused on allometric vancomycin dosing or simple AUC:MIC calculations. I would have liked to have found more guidance on interpretation of the data and appropriateness of when to use this tool.
8. GlobalRPh Vancomycin Dosing Calculators
Link to “single-level” calculator is here. Link to “original” calculator is here. Link to “timing of next dose based on Ke” calculator is here. Link to “actual trough” calculator is here. Link to “predicted trough level drawn early” calculator is here.
Owner: David McAuley, Pharm.D. and GlobalRPh Inc
Last updated: September 2017
Description: GlobalRPh provides several vancomycin dosing tools. I will focus on the “original calculator” here. An aminoglycoside and vancomycin calculator combined into one tool, this advanced resource allows the user to enter patient characteristics and dosing/ monitoring information, which it uses to generate dosing and monitoring recommendations. The tool generates a note template that can be exported for use in a medical record.
AUC output included: No
Impression: The various fonts and colors of the tool make it a bit difficult to navigate, but with regular use this would likely become less of an issue. I do not like how the vancomycin and aminoglycoside calculators are mixed into one tool and would prefer to have them separate. The other calculators noted above are not combined into one tool, which I like. I do like the functionality of this tool and how it generates a note template. I would prefer that more details and references were provided. This could be a tool useful for clinical practice or for students. There are so many separate calculators, it would be helpful if there were a “vancomycin dosing headquarters” of sorts to help users navigate the available resources more simply.
9. UCSF Adult Vancomycin Dosing Calculator (for download)
Link to download calculator is here half-way down the page.
Owner: Regents of the University of California
Last updated: Not found
Description: This downloadable Microsoft Excel file allows the user to navigate through tabs: patient info, initial dose, dose revision trough, dose revision two levels, and calculation details. As an Excel file it has limited aesthetics, however it does not lack in it’s capacity to generate outputs. On the page upon which this download is available, a vancomycin dosing and monitoring guide is provided.
AUC output included: yes
Impression: This is a great resource, because it offers a format allowing the user to see the equations and data in a different format from other free vancomycin calculators available online. It would take time to grow accustomed to using this tool, however since it is a Microsoft Excel file, it offers the user the option to modify it to their needs (although it may need to be done in a new file given many cells in this sheet are read-only). This could be good for students or working professionals or an institution looking to use a Microsoft Excel-based dosing program. It would be better if it could generate a note template or included an interactive graph output. Since I am familiar with the creator of this tool from this IDstewardship interview, I am not as concerned about not being able to identify when it was last updated.
10. Anirdesh.com Vancomycin Dosing Calculator
Link to calculator is here.
Owner: Pritesh Patel, PharmD
Last updated: Not found
Description: This tool is all on one page with tabs at the top. It has space to enter patient parameters, clearance, dosing regimen, prospective calculations, actual calculations, and iteration calculations. Equations for calculations are provided in a separate tab.
AUC output included: No
Impression: This calculator is moderate in complexity. Interpretation of data is a bit challenging in the way it is displayed and with the lack of descriptive information. I am not familiar with the creator of this tool and cannot identify when it was developed or last updated. It appears as though it may be a calculator that Dr. Patel created in his free time for fun. Proceed with caution.
11. Insight-Rx NeoVanco Vancomycin Dosing Calculator
Link to calculator is here.
Owner: Insight Rx, Inc
Last updated: Not found, must be after 2017 since that is the copyright on the webpage
Description: This website application is unique from other calculators listed here because it is specifically designed for vancomycin dosing in neonates. It is based off of a 2017 publication in Antimicrobial Agents and Chemotherapy available here. The user enters the post-menstrual age, weight and the renal function, then the calculator produces exposure prediction outputs, including columns of dose, mg/kg, frequency, AUC24, Ctrough, Pr(AUC>400), and PrCtrough>20). Custom dose calculations are also available.
AUC output included: Yes
Impression: This is a really neat calculator, but it’s use is limited of course to the neonatology population. Given it is provided by a parent company with a convincing professional presence, I would presume this could be a reliable tool for students or clinicians.
12. RxKinetics Vancomycin Kinetics WebApp Calculator
Link to calculator is here.
Owner: RxKinetics / someone with the first name “Rick”
Last updated: Not found
Description: This appears as a basic tool, but as you explore it there is depth to it. Once the user enters the patient’s age, height, weight, gender, and serum creatinine they can then select which drug model they want. Drug model options for vancomycin are “vancomycin normal” or “vancomycin outlier.” After selecting “view model” there are options for retrospective and prospective calculations. A graph is provided.
AUC output included: Yes
Impression: A more dynamic tool than first meets the eye, this calculator is almost too simple in design. I would like to see more data on each page and more guidance for interpretation, however the current design is likely a byproduct of this being a web app. I do appreciate the FAQs page. Given that it is not readily apparent who created this tool, what equations are used throughout, or when it was last updated, I would proceed with caution.
13. Stanford Medicine Vancomycin AUC Calculator (for download)
Link to calculator is here. Link to dosing/ monitoring protocol PDF is here.
Owner: Stanford Medicine
Last updated: September 2018
Description: This downloadable Microsoft Excel file has two tabs: intitial dose and AUC calculator. This file is less bulky than the UCSF one mentioned above, but has less complexity to it. It is easy to navigate and most cells are read-only.
AUC output included: Yes
Impression: This is a neat resource from a respected antimicrobial stewardship program. I like the format of the Excel file, as noted with the UCSF calculator above. This could be good for students or working professionals. I like the idea that a user could create their own tool using this as a base model.
Closing thoughts
Perhaps you are wondering: why don’t we just use a different drug if vancomycin is such a pain to dose and monitor?
Unfortunately there are limited alternatives that offer the range of benefits vancomycin does, particularly for empiric coverage when the infection type and offending organism are yet to be identified. As additional information is acquired after vancomycin is started, indeed providers should regularly consider whether vancomycin can be changed to an alternative or whether antibiotic therapy is needed at all.
As we continue to employ intravenous vancomycin, it will be interesting to witness how practice changes will occur over the next decade or so as AUC-based vancomycin decisions are likely to get more attention. Several of the vancomycin dosing calculators listed here appear to be useful tools for students and clinicians practicing within various organizations.
Learn Antibiotics
Recommended Readings
- Turner RB, et al. Review and Validation of Bayesian Dose-Optimizing Software and Equations for Calculation of the Vancomycin Area Under the Curve in Critically Ill Patients. Pharmacotherapy. 2018; 38 (12): 1174-83.
- Heil EL et al. Making the change to area under the curve–based vancomycin dosing. AJHP 2018.
- Fewel NP. Comparison of open‐access vancomycin dosing websites. JCPT 2016.
- Santimaleeworagun W et al. Comparison of vancomycin calculation programs in predicting steady state vancomycin trough concentrations among thai septic patients. TJPS 2018.
- Jeffers MN. The Whole Price of Vancomycin: Toxicities, Troughs, and Time. Drugs 2017.
- Allometric versus consensus guideline dosing in achieving target vancomycin trough concentrations. AJHP 2017.
- Chavad R et al. Towards individualised vancomycin dosing in Methicillin-resistant Staphylococcus aureus bacteraemia: establishment of an AUC0-24 threshold for nephrotoxicity. AAC 2017.
- Lodise TP et al. Vancomycin exposure in patients with methicillin-resistant Staphylococcus aureus bloodstream infections: how much is enough? CID 2016.
- Pai MP et al. Innovative approaches to optimizing the delivery of vancomycin in individual patients. ADDR 2014.
- Neely MN et al. Are Vancomycin Trough Concentrations Adequate for Optimal Dosing? AAC 2014
- Patel N et al. Vancomycin: We Can’t Get There From Here. CID 2011.
- Claeys K. MRSA Bloodstream Infection: Vancomycin, Daptomycin or Other? IDstewardship.com. 2016.
Other Vancomycin Dosing Resources
PkPd Compass (mobile app)
RxCalc (mobile app)
RxKinetics Lite (mobile app)
Disclaimer: The author of this article does not endorse the use of one calculator over any other and cannot attest to the current or future accuracy of any listed calculator.
Know about a vancomycin dosing calculator that is not listed here? Let us know here and we will consider adding it.
RECOMMENDED TO YOU: