Vancomycin loading doses in young infants and children
The role of vancomycin loading doses in young infants aged 0 to 90 days and children is currently unclear. Giving a loading dose of vancomycin before intermittent maintenance dosing achieves a therapeutic concentration more quickly (by 12 hours); however, clear evidence that this improves clinical or microbiological outcomes is lacking.
In young infants, the safety of loading doses is unclearDemirjian, 2013. A randomised trial1 of young infants found that abnormal hearing test results were reported in a greater proportion of those who received a loading doseDemirjian, 2013Hill, 2022; long-term safety data are pending.
In children older than 3 months, loading doses are not associated with a significant increase in nephrotoxicity; however, infusion-related reactions are more frequentDolan, 2020.
Loading doses should not routinely be used in young infants and children; seek expert advice if considering a loading dose.