title: Evaluation of weight-based vancomycin dosing for hospitalized hemodialysis patients.
abstract: BACKGROUND
  Current vancomycin dosing guidelines recommend targeting trough concentrations of 15-20 mg/L in complicated infections to avoid treatment failure and resistance. How to accomplish this in the intermittent hemodialysis (IHD) population has not been adequately described. A weight-based vancomycin dosing protocol for IHD patients was developed to provide standardization of vancomycin dosing for this patient population. Prior to implementation of this protocol, clinical pharmacists used their individual judgment for dosing and monitoring.
  
  
  OBJECTIVE
  Compare achievement of goal (15-20 mg/L) pre-IHD vancomycin levels between a group of patients dosed prior to implementation of this weight-based vancomycin dosing protocol and a group dosed after implementation.
  
  
  METHODS
  This retrospective study evaluated hospitalized IHD patients who received vancomycin and had an appropriate pre-IHD vancomycin level. Any patients with acute kidney injury or who required continuous renal replacement therapy or peritoneal dialysis were excluded.
  
  
  RESULTS
  A total of 145 vancomycin courses (94 pre-protocol and 51 post-protocol) were included in this study. The post-protocol group had an increased percentage of patients who achieved a pre-IHD vancomycin level of 15-20 mg/L. We also found improvement in pre-IHD vancomycin levels attained in patients weighing less than 75 kg and the need for additional study in patients weighing more than 105 kg.
  
  
  CONCLUSIONS
  Simplifying and standardizing vancomycin dosing for hospitalized IHD patients based on weight resulted in 37% of patients achieving goal pre-IHD vancomycin level of 15-20 mg/L with zero patients having a pre-IHD vancomycin level <10 mg/L.
authors.affiliation: a Department of Pharmacy Practice , Harrison School of Pharmacy, Auburn University , Birmingham , AL , USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Maxson
authors.affiliation: b Department of Pharmacy , Centennial Medical Center , Nashville , TN , USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Pate
authors.affiliation: a Department of Pharmacy Practice , Harrison School of Pharmacy, Auburn University , Birmingham , AL , USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Starr
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001835:Body Weight; D016903:Drug Monitoring; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Vancomycin; antimicrobial; dialysis; drug monitoring; kidney failure