High single-dose vancomycin loading is not associated with increased nephrotoxicity in emergency department sepsis patients.

Link to article at PubMed

High single-dose vancomycin loading is not associated with increased nephrotoxicity in emergency department sepsis patients.

Acad Emerg Med. 2016 Feb 6;

Authors: Rosini JM, Davis JJ, Muenzer J, Levine BJ, Papas MA, Comer D, Arnold R

Abstract
OBJECTIVE: Vancomycin loading doses are recommended, however, the risk of nephrotoxicity with these doses is unknown. The primary objective of this study was to compare nephrotoxicity in emergency department (ED) sepsis patients who received vancomycin at high doses (>20 mg/kg) versus lower doses (≤20 mg/kg).
METHODS: A retrospective cohort study was performed in three academic EDs.
INCLUSION CRITERIA: age ≥ 18 years, IV vancomycin order, and hospital admission.
EXCLUSION CRITERIA: no documented weight, hemodialysis-dependent, inadequate serum creatinine (SCr) values for the measured outcome. Analyses compared the incidence of nephrotoxicity for patients who received vancomycin at high dose (>20 mg/kg) vs. low dose (≤20 mg/kg).
RESULTS: A total of 2,131 consecutive patients prescribed vancomycin over 6 months were identified. Of these, 1,330 patients had three SCr values assessed for the primary outcome. High dose initial vancomycin was associated with a significantly lower rate of nephrotoxicity (5.8% vs 11.1%). After adjusting for age, gender, and initial SCr, the risk of high dose vancomycin compared to low dose was decreased for the development of nephrotoxicity (RR=0.60; 95% CI: 0.44, 0.82).
CONCLUSION: Initial dosing of vancomycin >20 mg/kg, was not associated with an increased rate of nephrotoxicity compared with lower doses. Findings from this study support compliance with initial weight-based vancomycin loading doses. This article is protected by copyright. All rights reserved.

PMID: 26850378 [PubMed - as supplied by publisher]

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