OBJECTIVES: There are many dosing strategies of vancomycin dose in end stage renal disease (ESRD) patients. Appropriate dosing of antibiotic is important in order to reduce the development of antimicrobial resistance. In our local setting the current practice is to give vancomycin dose of 20mg/kg as initial loading dose. This study aimed to determine the adequacy of current initial vancomycin loading dose by reviewing the resultant vancomycin trough level.

METHODS: This observational study was conducted from December 2016 until December 2017. All ESRD patients who started with intravenous vancomycin, on high flux dialyzer if hemodialysis is done, and sampling time on day 3 after initiation of vancomycin were included. Descriptive statistics were used to depict the demographic data and proportions of patients achieving therapeutic range and those not achieving therapeutic range. Percentage of patients that achieved subtherapeutic (<10 mg/L), therapeutic (10 – 20 mg/L) and supratherapeutic level (>20 mg/L) were calculated.

RESULTS: Out of 35 patients, majority achieved therapeutic level (n=30, 86%) followed by subtherapeutic level (n=3, 8 %) and only 6% (n=2) achieved supratherapeutic level. The overall mean ± SD serum vancomycin trough concentration is 15.3 ± 3.6 (95% CI, 14.1 to 16.5 mg/L). However, no associations between age, race, urine output, gender and dialysis with vancomycin level were identified.

CONCLUSIONS: This study revealed that initial vancomycin weight based loading dose of 20mg/kg is adequate to be used in ESRD patients. Nevertheless further study with larger sample size is required to evaluate other factors that may affect vancomycin level.