Evaluation of a vancomycin dosing nomogram based on the Modification of Diet in Renal Disease equation in intensive care unit patients

Purpose: The purpose of the study is to evaluate the effectiveness of a vancomycin nomogram using actual body weight and the Modification of Diet in Renal Disease equation to estimate renal function in intensive care unit patients. Methods: Retrospective evaluation (preimplementation group, n = 57) was conducted from March 2011 to April 2011. Prospective evaluation was conducted after nomogram implementation (postimplementation group, n = 60) from December 2011 to February 2012. Results: The percentage of patients with an initial vancomycin trough concentration 15 μg/mL or higher increased in the postimplementation group as compared with the preimplementation group (72% vs 39%, P = .0004). The postimplementation group also demonstrated an increase in the percentage of patients with initial trough concentration between 15 and 20 μg/mL (42% vs 19%, P = .0099), and no statistical difference in the percentage of patients with an initial trough greater than 20 μg/mL (30% vs 19%, P = .2041). There was no difference in nephrotoxicity in the postimplementation group compared with the preimplementation group (18% vs 17.5%, P = 1.0). Conclusion: Use of a vancomycin nomogram increased the percentage of initial vancomycin trough concentrations 15 μg/mL or higher in intensive care unit patients and was not associated with an increased occurrence of nephrotoxicity.