Category: Pharmacology & Therapeutics
Keywords: obese, vancomycin, loading dose (PubMed Search)
Vancomycin guidelines recommend an initial dose of 15-20 mg/kg based on actual body weight (25-30 mg/kg in critically ill patients).  The MRSA guidelines further recommend a max dose of 2 gm. 
But, what dose do you give for an obese patient that would require more than 2 gm?
A new study provides some answers to this question.  Obese-specific, divided-load dosing achieved trough concentrations of 10 to 20 g/mL for 89% of obese patients within 12 hours of initial dosing and 97% of obese patients within 24 hours of initial dosing.
Application to Clinical Practice
The study used some more specific dosing calculations based on renal function and percentage above IBW. If patient's renal function is abnormal, consultation with a pharmacist is recommended.
Follow me on Twitter (@PharmERToxGuy) or Google Plus (+bryanhayes13)