Performance of a divided-load intravenous vancomycin dosing strategy for critically ill patients

Area of Science:

• Pharmacology
• Critical Care Medicine
• Infectious Diseases

Background:

• Current vancomycin guidelines recommend trough concentrations of 15-20 µg/mL for complicated infections.
• Higher trough concentrations are recommended for all infections, with a minimum threshold of 10 µg/mL.

Purpose of the Study:

• To evaluate a novel divided-load vancomycin protocol in critically ill patients.
• The protocol aims to achieve target trough concentrations within 24 hours of initiation.
• The protocol is designed to prevent supratherapeutic vancomycin dosing.

Main Methods:

• Retrospective review of 79 critically ill patients' medical records.
• Vancomycin serum concentrations were measured before the third dose and after any dosing adjustments.
• Steady-state concentrations were assessed before the fifth or sixth doses; early concentrations were predicted using an algorithm.

Main Results:

• 90% of patients on scheduled doses achieved therapeutic vancomycin concentrations within 12-24 hours.
• Patients exceeding 150% of ideal body weight were more likely to have supratherapeutic concentrations.
• All 8 dialysis-dependent patients achieved therapeutic concentrations within 12 hours.

Conclusions:

• The divided-load vancomycin dosing strategy successfully achieved target trough concentrations (15-20 µg/mL) in most critically ill patients within 24 hours.
• This protocol effectively prevented supratherapeutic vancomycin dosing.
• The strategy demonstrated efficacy in achieving therapeutic vancomycin levels in critically ill patients, including those with renal complications.