Report on the Effect of Vancomycin Loading Dose on the Initial Area Under the Time-Concentration Curve in Critically Ill Patients with Impaired Renal Function or Patients Undergoing Continuous Renal Replacement Therapy

Abstract

The efficacy index of vancomycin (VCM), an antibiotic widely used in the critical care setting, is defined as an area under the time-concentration curve (AUC) ≥ 400, and an early loading dose is recommended to increase blood concentrations at an early stage. A correlation between the AUC up to 24 hours after the start of administration (AUC_0-24hr) and therapeutic effect has also been reported. However, there are few reports on the effect of the initial loading dose on AUC_0-24hr in the critical care setting. In the present study, we compared the rate of achieving an AUC_0-24hr ≥ 400 between the loading dose (LD) group and the no loading dose (ND) group in critically ill patients with impaired renal function or patients undergoing continuous renal replacement therapy. The rate of achieving an AUC_0-24hr ≥ 400 was significantly increased to 81.4％ in the LD group compared to 45.2％ in the ND group (P < 0.005), and the presence of a loading dose was extracted as a factor affecting the rate at which an AUC_0-24hr ≥ 400 was achieved with an odds ratio of 9.1. Administration of a loading dose of vancomycin in critically ill patients with impaired renal function or patients undergoing continuous renal replacement therapy may help achieve the target AUC earlier.