Vancomycin loading dose and AUC

backgroundAchieving target vancomycin exposures is crucial for treating pediatric sepsis but is complicated by altered pharmacokinetics in critically ill children. This study investigated whether a loading dose improve target attainment of the area under the concentration curve in the first 24 h (AUC

methodsThis single-center, open-label, randomized controlled trial enrolled pediatric sepsis patients (3 months - 18 years) at King Chulalongkorn Memorial Hospital, Thailand. Patients were randomized 2:1 to receive a vancomycin loading dose or a standard dose. The primary outcome was achieving target AUC

resultsOf 78 participants (loading dose n = 51; standard dose n = 27), overall target AUC₀₋₂₄ attainment did not differ significantly. However, the loading dose reduced AUC

conclusionAlthough a loading dose did not increase overall target AUC₀₋₂₄ attainment, it reduced AUC IMPACT: This randomized controlled trial showed that vancomycin loading doses in pediatric sepsis patients significantly reduced the proportion of patients with area under the concentration curve (AUC) in the first 24 h that were underdosing compared to the standard dose. The loading dose also improved target attainment of AUC over 24 h at steady-state levels, without increasing the risk of serious adverse events. This study highlights the importance of optimizing vancomycin dosing, particularly in patients with augmented renal clearance. These findings support incorporating a loading dose strategy into vancomycin therapy for pediatric sepsis patients, especially those with augmented renal clearance.