Vancomycin Dosing for Patients Undergoing SLED

Introduction to Vancomycin Dosing

The American College of Critical Care Medicine recommends loading doses of 25-30 mg/kg for seriously ill patients with suspected MRSA infection who have not yet received vancomycin, to achieve rapid therapeutic concentrations in critically ill patients with expanded extracellular volume from fluid resuscitation 1, 2
Loading doses are not affected by renal function and should be given regardless of kidney status, but are not indicated when a patient is already on vancomycin therapy 1, 2

For patients already on vancomycin starting SLED, do not give a loading dose unless the patient has never received vancomycin before or pre-SLED levels are subtherapeutic and the patient has severe sepsis/septic shock 1, 2
Administer a supplemental dose post-SLED of at least 500-1000 mg after each dialysis session to replace drug removed during dialysis, to maintain therapeutic concentrations 1, 2