Weight-based vancomycin loading strategy may not improve achievement of optimal vancomycin concentration in patients with preserved renal function

Abstract

We performed a retrospective study to evaluate clinical effectiveness of vancomycin loading strategy and factors associated with achieving optimal C_min. Patients administered vancomycin for ≥72 h from January to June 2018 were enrolled. Patients were divided into two groups: loading (LD) and non-loading (NLD). LD was defined as initial vancomycin dose ≥20 mg/kg and ≥120% of maintenance dose. During study period, 70 and 71 received initial LD (24.2 ± 2.5 mg/kg) and NLD (17.3 ± 3.3 mg/kg) doses of vancomycin, respectively (p < .001). Achievement of optimal C_min was not different before administration of the third dose (24.4% in LD versus 18.2% in NLD, p = .484) and within 72 h (22.9% versus 28.2%, p = .759). Risk factors for failure to achieve optimal C_min before administration of the third dose were higher creatinine clearance and higher level of serum albumin. Therefore, more sufficient loading or patient-specific dose strategies should be used to achieve optimal serum vancomycin C_min.

Keywords:

• Vancomycin
• therapeutic drug monitoring
• trough level
• loading dose
• renal function
• hypoalbuminemia

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Ministry of Trade, Industry & Energy (MOTIE, Republic of Korea) under the Industrial Technology Innovation Program [No. 10080648].

Notes on contributors

Si-Ho Kim

Si-Ho Kim, Infectious disease specialist, is a clinical professor at the Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon.

Cheol-In Kang, Infectious disease specialist, is a professor at the Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Soo-Hyun Lee is an internal medicine resident in Samsung Medical Center.

Joon-Sik Choi, Pediatric specialist, is now working at the Yongin Severance Hospital Kyungmin Huh, Infectious disease specialist, is a clinical assistant professor at the Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Sun Young Cho, Infectious disease specialist, is a clinical assistant professor at the Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Doo Ryeon Chung, Infectious disease specialist, is a professor at the Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Hyo Jung Park, Clinical pharmacist, is working at the Department of Pharmaceutical Services, Samsung Medical Center, Seoul.

Soo-Youn Lee, Clinical pathologist, is an associate professor at the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Yae-Jean Kim, Pediatric specialist, is a professor at the Division of Pediatric Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Kyong Ran Peck, Infectious disease specialist, is a professor at the Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, and a chairman of the The Korean Society of Infectious Diseases.