Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines

Xia XU; Puqiong FENG; Shanshan LU; Jin HE

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Xia XU, Puqiong FENG, Shanshan LU, Jin HE. Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines[J]. Journal of Kunming Medical University.

Citation:

Xia XU, Puqiong FENG, Shanshan LU, Jin HE. Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines[J]. Journal of Kunming Medical University.

Xia XU, Puqiong FENG, Shanshan LU, Jin HE. Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines[J]. Journal of Kunming Medical University.

Citation:

Xia XU, Puqiong FENG, Shanshan LU, Jin HE. Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines[J]. Journal of Kunming Medical University.

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Analysis of Initial Vancomycin Dosing Regimens for Elderly Patients Based on Guidelines

Clinical Pharmacy Center，The First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

Received Date: 2025-07-08
Available Online: 2026-04-26

Abstract

Abstract

Objective To analyze the achievement rate of steady-state trough concentrations （hereinafter referred to as trough concentrations） and the occurrence of nephrotoxicity in elderly patients receiving vancomycin, and to explore the appropriateness of initial dosing regimens based on the Chinese Guidelines for Therapeutic Drug Monitoring of Vancomycin （2020 Update）. Methods Clinical data of 307 elderly patients treated with vancomycin were retrospectively collected. Patients were stratified by creatinine clearance （Ccr）, and the achievement rate of trough concentrations and the incidence of nephrotoxicity were analyzed for different dosing regimens within each Ccr stratum. Results Only 39.8% of the initial dosing regimens in elderly patients were consistent with the guideline recommendations, and 41.6% of patients had daily doses exceeding the recommended range. The overall achievement rate of vancomycin trough concentrations was 41.7%, with statistically significant differences among different Ccr groups（χ² = 24.652, P = 0.006）. In the Ccr 30～39.99 mL/min group, the achievement rates of the 1g qd and 0.5g q12 h regimens were higher than that of the 0.5g qd regimen （P = 0.007）; in the Ccr 40～54.99 mL/min group, the achievement rate of the 0.5g q8 h regimen was higher than those of the 1g qd and 0.5g q12 h regimens （P = 0.006）. The overall incidence of nephrotoxicity was 16.9%. Multivariate analysis identified age, ICU admission, and vancomycin trough concentration as independent risk factors for nephrotoxicity in elderly patients. Conclusion For elderly patients with Ccr 30～54.99 mL/min, optimizing the dosing regimen based on guideline recommendations （1g qd or 0.5g q12 h for Ccr 30～39.99 mL/min; 0.5g q8 h for Ccr 40～54.99 mL/min） could improve the achievement rate of trough concentrations without significantly increasing the risk of nephrotoxicity.
- Vancomycin,
- Elderly patients,
- Trough concentration

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