Pharmacokinetic Assessment of Vancomycin Loading Dose in Critically Ill Patients [PublishAheadOfPrint]

Background: The vancomycin loading dose (LD) of 25-30 mg/kg is a frequently practiced strategy to achieve effective concentrations from the first-treatment dose. However, considering only the body weight for dosing might be inadequate in critically ill patients due to pharmacokinetics changes.

Objective: Assess achieving optimal trough serum levels of vancomycin and AUC_0–24/MIC in the first 24-hours of treatment, by using a LD based on population pharmacokinetic parameters of critically ill patients.

Methods: We performed a concurrent cohort study over 22 months of patients with severe sepsis who received intravenous vancomycin. The patients were treated with three different strategies to initiate vancomycin: without LD (Group A), with LD of 25-30 mg/kg (Group B), and with LD based on population pharmacokinetic parameters of the critically ill patient (Group C).

Results: An optimal trough serum concentration was achieved in 5%, 9% and 83% of patients in Group A, B and C, respectively. The number of patients that reached optimal AUC_0–24, was 2 out of 18 (11%), 5 out of 11 (46%), and 11 out of 12 (92%) on Groups A, B and C, respectively. The statistical analysis for both parameters revealed significant differences in Group C, with respect to other groups.

Conclusions: The administration of LD calculated from population pharmacokinetic parameters from the beginning of therapy is a more efficient strategy to obtain adequate trough serum concentrations and AUC_0–24/MIC in critical patients.

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