Vancomycin trough level and loading dose

Vancomycin trough level and loading dose Felipe Francisco Tuon,1 Rudson Romero,2 Juliano Gasparetto,2 Juliette Cieslinski1 1Laboratory of Microbiology and Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; 2School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, BrazilDear editorWe read with interest the paper by Barceló-Vidal et al1 about vancomycin nephrotoxicity due to high trough levels with histopathology. The authors described a case developing both lesions and described total vancomycin washout after a biopsy-proven vancomycin toxicity. Unfortunately, most patients receiving the loading dose of >25 mg/kg do not achieve adequate trough level, which was recommended by some guidelines to be between 15 and 20 mg/L.2 Considering this issue, we performed a brief study in two Brazilian hospitals with therapeutic drug monitoring (TDM) of vancomycin and loading dose of 30 mg/kg. The inclusion criteria for the retrospective observational study were as follows: patients were aged >18 years, admitted to an intensive care unit (ICU), with infection, and received at least 72 hours of vancomycin, with the creatinine level of