Vanc in critically ill patients

Q: Critically ill patients may require ___________ vancomycin loading doses? - select one

A) higher

B) lower

Answer: A

Critically ill patients usually have a high volume of distribution, which may increase vancomycin clearance. These patients may require higher vancomycin loading doses up to 25 to 30 mg/kg to achieve optimal vancomycin levels, particularly in the initial phase of illness. 

In these patients, it should be kept in mind that concomitant renal insufficiency or the need for renal replacement therapy/dialysis may significantly alter the need. Close monitoring of peak and, particularly, trough levels should guide therapy.

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References:

1. Pongchaidecha M, Changpradub D, Bannalung K, et al. Vancomycin Area under the Curve and Pharmacokinetic Parameters during the First 24 Hours of Treatment in Critically Ill Patients using Bayesian Forecasting. Infect Chemother 2020; 52:573.

2. Ishigo T, Ibe Y, Fujii S, et al. Effect of renal clearance on vancomycin area under the concentration-time curve deviations in critically ill patients. J Infect Chemother 2023; 29:769.

3. Alsultan A, Dasuqi SA, Almohaizeie A, et al. External Validation of Obese/Critically Ill Vancomycin Population Pharmacokinetic Models in Critically Ill Patients Who Are Obese. J Clin Pharmacol 2024; 64:353.