UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Vancomycin Loading Doses in ED Not Associated with Increased Nephrotoxicity

Keywords: vancomycin, loading dose, nephrotoxicity (PubMed Search)

Posted: 3/24/2016 by Bryan Hayes, PharmD (Emailed: 4/2/2016) (Updated: 4/2/2016)
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Guidelines recommend loading doses of vancomycin (15-20 mg/kg, up to 30 mg/kg in critically ill patients), but the risk of nephrotoxicity is unknown. A new retrospective cohort study aimed to compare nephrotoxicity in ED sepsis patients who received vancomycin at high doses (>20 mg/kg) versus lower doses (20 mg/kg).

What They Found

  • 1,330 patients had three SCr values assessed for the primary outcome

  • High-dose initial vancomycin was actually associated with a lower rate of nephrotoxicity (5.8% vs 11.1%)

  • After adjusting for age, gender, and initial SCr, the risk of high dose vancomycin compared to low dose was decreased for the development of nephrotoxicity (RR=0.60; 95% CI: 0.44, 0.82)

Application to Clinical Practice

It appears initial loading doses of vancomcyin > 20 mg/kg do not cause increased risk of nephrotoxicity.


Rosini JM, et al. High single-dose vancomycin loading is not associated with increased nephrotoxicity in emergency department sepsis patients. Acad Emerg Med. 2016 Feb 6. Epub ahead of print. [PMID 26850378]

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