title: High Single-dose Vancomycin Loading Is Not Associated With Increased Nephrotoxicity in Emergency Department Sepsis Patients.
abstract: 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).
  
  
  
  A retrospective cohort study was performed in three academic EDs. Inclusion criteria were age ≥ 18 years, intravenous vancomycin order, and hospital admission. Exclusion criteria were no documented weight, hemodialysis-dependent, and 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) versus low dose (≤20 mg/kg).
  
  
  
  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 age, sex, and initial SCr were adjusted for, the risk of high-dose vancomycin compared to low-dose was decreased for the development of nephrotoxicity (relative risk = 0.60; 95% confidence interval = 0.44 to 0.82).
  
  
  
  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.
authors: Department of Pharmacy, Christiana Care Health System, Newark, DE.
authors: Jamie M
authors: JM
authors: Rosini
authors: Department of Emergency Medicine, Christiana Care Health System, Newark, DE.
authors: Joshua J
authors: JJ
authors: Davis
authors: Department of Emergency Medicine, Christiana Care Health System, Newark, DE.
authors: Jeffrey
authors: J
authors: Muenzer
authors: Department of Emergency Medicine, Christiana Care Health System, Newark, DE.
authors: Brian J
authors: BJ
authors: Levine
authors: Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE.
authors: Mia A
authors: MA
authors: Papas
authors: Value Institute, Christiana Care Health System, Newark, DE.
authors: Dominique
authors: D
authors: Comer
authors: Department of Emergency Medicine, Christiana Care Health System, Newark, DE.|Value Institute, Christiana Care Health System, Newark, DE.
authors: Ryan
authors: R
authors: Arnold
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001835:Body Weight; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin