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Vancomycin dosing in renal impairment — GPhC CRA MCQ

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HardInfection TherapeuticsVancomycin dosing in renal impairmentGPhC CRA

A hospital pharmacist is checking a prescription for intravenous vancomycin in a patient with a suspected MRSA bacteraemia. The patient weighs 90 kg and has an eGFR of 35 mL/min/1.73m². The prescribed loading dose is 25 mg/kg. What is the most important consideration?

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Correct answer: C — The loading dose does not need adjustment in renal impairment

The loading dose of vancomycin is based on actual body weight and is not adjusted for renal impairment. However, subsequent maintenance doses must be adjusted based on renal function and guided by therapeutic drug monitoring (trough levels). The loading dose ensures adequate initial drug concentrations regardless of renal status. The BNF states the loading dose is 25-30 mg/kg regardless of renal function.

Reference: https://www.pharmacyregulation.org/registration-assessment#stage-8-order-18