Loading Vancomycin Doses in the Emergency Department
| Status: | Completed |
|---|---|
| Conditions: | Infectious Disease, Hospital |
| Therapuetic Areas: | Immunology / Infectious Diseases, Other |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 10/21/2012 |
| Start Date: | July 2010 |
| End Date: | January 2013 |
| Contact: | Melissa Bollinger, RN, BSN |
| Email: | mbollinger@christianacare.org |
| Phone: | 302-733-4189 |
A Randomized Prospective Study of Vancomycin Dosing in the Emergency Department: Will a Loading Dose of 30mg/kg Lead to a More Rapid Attainment of Therapeutic Levels?
In 2008, our ED administered an average of 245 doses of vancomycin per month. Currently
there is no consistency in the ED practice in regards to vancomycin dosing. In 2009, the
IDSA put forth new recommendations for vancomycin dosing in order to achieve therapeutic
levels more rapidly. It has been hypothesized that if therapeutic levels are reached more
rapidly then patients will in turn have better clinical outcomes and that the development of
resistant organisms will be decreased. Methicillin resistant Staphylococcus aureus (MRSA)
has emerged as one of the most deadly pathogens that are currently plaguing our patient
population. Vancomycin is one of only a few antibiotics that are effective for treating
MRSA. It is imperative that the ED physicians consistently and correctly dose vancomycin in
order to give the patients the best chance to fight infection while helping to prevent
further resistance in this already highly resistant organism. It is believed this study will
reveal that the new dosing recommendations by the IDSA will lead to the achievement of
therapeutic levels more rapidly. This information will in turn help to convince ED
physicians that a change in current clinical practice is warranted and ultimately lead to
better clinically outcomes for the patients.
Recently, the Infectious Disease Society of America (IDSA) has released new dosing
recommendations for intravenous (IV) vancomycin. These new recommendations suggest
administering an initial dose of 25-30 mg/kg of vancomycin as opposed to 10-15 mg/kg which
is more traditionally done. Currently in the Emergency Department (ED) some practitioners
are using the new IDSA dosing recommendations for vancomycin, while other practitioners have
not changed their clinical practice. There is currently little data available to suggest
that implementing these new vancomycin dosing regimens in the ED will achieve therapeutic
vancomycin levels more rapidly than our traditional dosing practice.
Inclusion Criteria:
- At least 18 years of age
- Treated in Christiana Emergency Department
- Receiving Vancomycin for an infection or presumed infection
- Being admitted to Christiana Hospital
- Planned continued use of Vancomycin after admission.
Exclusion Criteria:
- Less than 18 years of age
- Weight greater than 120 kg.
- Concurrent use of aminoglycosides or acyclovir
- Sepsis patients being admitted to ICU with presumed diagnosis of pneumonia
- Patients currently undergoing dialysis
- Pregnant or breast feeding
- No plan to continue Vancomycin after admission.
- Creatinine clearance less than 50ml/min.
We found this trial at
1
site
Click here to add this to my saved trials
