Should patients treated with vancomycin get loading doses?
We know guidelines call for aggressive dosing due to increasing MICs...including loading doses for serious infections.
Now new evidence is shedding more light on benefits and risks.
Loading doses do help reach trough levels ≥ 15 mg/L after the first dose...in at least 30% of patients compared to less than 10% of those who don't get them.
But there's still no proof that loading doses improve outcomes...and they may slightly increase the risk of nephrotoxicity.
Divided loading doses... 15 mg/kg every 6 or 12 hours depending on CrCl...are sometimes tried to reduce high troughs in ICU patients. But don't incorporate these into your practice yet.
Continue to use vanc loading doses of 25 to 30 mg/kg in seriously ill adult patients. They may be especially useful for reaching target troughs sooner in those with impaired renal function...where the half-life and dosing interval will be longer.
Use actual body weight to calculate loading doses. Consider a strategy to prevent over- or underdosing in obese patients...such as capping the load at 2.5 g. Some experts also recommend checking two levels afterward to calculate kinetic parameters.
Keep in mind, the risk of "red man syndrome" goes up with higher doses. Ensure doses ≥ 2 g are infused over at least two hours.
Use our PL Detail-Document, Vancomycin Dosing and Monitoring for Adults, for more tips on maintenance doses and when to check blood levels.
Ann Pharmacother Published online Feb 23, 2015; doi:10.1177/1060028015571163. Ann Pharmacother 2015;49:6.]