There had been some social media buzz about dosing vanco correctly awhile back, primarily based off this post on ALIEM. The comments section is full of good tidbits as well. Now, I’m starting to see articles suggesting using CPOE to correctly dose vancomycin.
Cart before the horse much?
This study (403 total patients) showed an insignificant difference in mortality for MRSA bacteremia in an ICU setting when comparing usual care vs weight based vanco dosing. This one (92 total patients) looked at geriatric MRSA bacteremic patients and also found no difference in morbidity or mortality. There is literally no study I’ve been able to find that directly looks at morbidity and mortality for weight based vanco dosing in the adult population.
If you want to talk about reaching ideal vanco levels earlier in disease course, that’s fine, but this commonly cited study only looked at the outcomes of 35 patients. Rather, consider a continuous vancomycin infusion, which to date has more patient-centered data than weight based dosing.
Let’s slow down with these studies showing CPOE makes “appropriate” vanco dosing easier since we already have two studies showing weight based dosing of vancomycin does not make a meaningful clinical difference.