Methods: Initially, standardized forms utilized by pharmacy in tracking vancomycin usage allowed a retrospective review of all OLOLCH patients receiving vancomycin. Vancomycin dosing was increased from 60 milligram/kilogram/day (mg/kg/day) to 70 mg/kg/day. After excluding patients with documented renal dysfunction and those who never had a vancomycin level drawn, data regarding patient’s age, associated diagnoses, vancomycin dosing and trough levels, and laboratory results were analyzed.
Results: Of the 206 patients given 60 mg/kg/day, 149 (72%) were subtherapeutic, 51 (25%) were therapeutic, and 6 (3%) were supratherapeutic using initial trough levels. Fifty patients were given 70 mg/kg/day – 31 (62%) were subtherapeutic, 14 (28%) were therapeutic, and 5 (10%) were supratherapeutic. The median trough level was 7.2 mg/L and 8.3 mg/L for the 60 mg/kg/day and 70 mg/kg/day doses, respectively (p<0.001). While there was a larger percent of patients who had supratherapeutic levels on the higher dose, only 1 (a 29 day old) of 5 had a trough greater than 22 mg/L. No patient had vancomycin toxicity or renal impact in either group. Anecdotally, a larger percentage of patients in the higher dose group experienced redman syndrome.
Conclusion: We were able to demonstrate a significantly higher vancomycin trough level with a higher starting dose of 70 mg/kg/day without negatively impacting renal function though likely producing increased incidence of drug reaction (i.e., Redman Syndrome). However, most patients still had subtherapeutic trough levels though additional study and analyses is needed to determine if higher dosing is clinically beneficial.
M. Bolton, None