title: A randomized trial of loading vancomycin in the emergency department.
abstract: BACKGROUND
  Optimizing vancomycin dosing may help eradicate bacteria while avoiding resistance. The guidelines recommend loading doses; however, there are no data to demonstrate that this may result in a more rapid achievement of therapeutic troughs.
  
  
  OBJECTIVE
  To evaluate the percentage of troughs reaching therapeutic levels at 12, 24, and 36 hours following an initial vancomycin dose of 30 mg/kg compared with 15 mg/kg.
  
  
  METHODS
  This prospective, randomized study was performed in a community academic medical center. Patients who were to receive vancomycin in the emergency department were randomized to an initial traditional dose of 15 mg/kg or a 30-mg/kg loading dose followed by 15 mg/kg every 12 hours for 3 doses. Patients weighing >120 kg or with creatinine clearances <50 mL/min were excluded.
  
  
  RESULTS
  In total, 99 patients were enrolled; 12 hours after the initial dose of vancomycin, there was a significantly greater proportion of patients reaching target trough levels of 15 mg/L among the patients who received a loading dose as compared with a traditional dose (34% vs 3%, P < 0.01). This trend continued at 24 hours but was not statistically significant. At 36 hours, there was no difference in the percentage of patients reaching target levels between the 2 groups. No statistically significant difference in nephrotoxicity or adverse events among the 2 groups was demonstrated.
  
  
  CONCLUSIONS
  A loading dose of 30 mg/kg of vancomycin achieved a higher percentage of therapeutic levels at 12 hours when compared with the traditional dose of 15 mg/kg, without increased nephrotoxicity or adverse events.
authors.affiliation: Christiana Care Health System, Newark, DE, USA jrosini@christianacare.org.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rosini
authors.affiliation: Christiana Care Health System, Newark, DE, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Laughner
authors.affiliation: Christiana Care Health System, Newark, DE, USA Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Levine
authors.affiliation: University of Delaware, Newark, DE, USA.
authors.forename: Mia A
authors.initials: MA
authors.lastname: Papas
authors.affiliation: Christiana Care Health System, Newark, DE, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Reinhardt
authors.affiliation: Christiana Care Health System, Newark, DE, USA Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Jasani
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: emergency department; pharmacokinetics; trough; vancomycin