Comparative Safety of Administering a Loading Dose of Vancomycin to Patients with Renal Impairment and Normal Renal Function

Abstract

The revised TDM Clinical Practice Guidelines for Antibiotics published in February, 2022 recommend administering a loading dose of vancomycin (VCM) to patients with renal impairment (eGFR <80 (mL/min/1.73m²)). Herein, we investigated the efficacy and safety of administering a loading dose of VCM to our patients with an eGFR <80 compared with those with an eGFR ≥80. The nomogram of our hospital specifies VCM loading doses of 1 g and 1.5 g for body weights <55 kg and ≥55 kg, respectively. The maintenance dose was set to a fixed value for each creatinine clearance value (mL/min). Renal dysfunction was not detected in the eGFR <80 group (n = 59) compared with an incidence of 9.0％ in the eGFR ≥80 group (n = 11). The incidence of acute kidney injury did not significantly differ between groups (8.4％, eGFR <80 group; 9.0％, eGFR ≥80 group). The average value of the initial VCM trough concentrations did not significantly differ between groups (10.8 ± 4.1 μg/mL, eGFR <80 group; 10.6 ± 3.8 μg/mL, eGFR ≥80 group). These results indicate that administering a loading dose of VCM to patients with renal impairment (eGFR <80) is safe. The loading dose may be appropriate in this study.