Weight-based vancomycin loading strategy may not improve achievement of optimal vancomycin concentration in patients with preserved renal function

We performed a retrospective study to evaluate clinical effectiveness of vancomycin loading strategy and factors associated with achieving optimal C _min. Patients administered vancomycin for ≥72 h from January to June 2018 were enrolled. Patients were divided into two groups: loading (LD) and non-loading (NLD). LD was defined as initial vancomycin dose ≥20 mg/kg and ≥120% of maintenance dose. During study period, 70 and 71 received initial LD (24.2 ± 2.5 mg/kg) and NLD (17.3 ± 3.3 mg/kg) doses of vancomycin, respectively (p <.001). Achievement of optimal C _min was not different before administration of the third dose (24.4% in LD versus 18.2% in NLD, p =.484) and within 72 h (22.9% versus 28.2%, p =.759). Risk factors for failure to achieve optimal C _min before administration of the third dose were higher creatinine clearance and higher level of serum albumin. Therefore, more sufficient loading or patient-specific dose strategies should be used to achieve optimal serum vancomycin C _min.