Abstract: TH-PO0826
Optimizing Vancomycin Dosing in Haemodialysis: Effect of a Revised Weight-Based Protocol in a Singapore Hospital
Session Information
- Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Quek, Karmen, Changi General Hospital, Singapore, Singapore
- Ow Yong, Pu En, Changi General Hospital, Singapore, Singapore
- Heng, Nicole, Changi General Hospital, Singapore, Singapore
- Ng, Joey Jingsen, Changi General Hospital, Singapore, Singapore
- Koh, Xuan Han, Changi General Hospital, Singapore, Singapore
- Chionh, Chang Yin, Changi General Hospital, Singapore, Singapore
Background
Vancomycin dosing in haemodialysis patients is complicated by variability in local practice. In 2021, Changi General Hospital adapted and implemented the ASHP/PIDS/SIDP/IDSA revised consensus guideline for therapeutic monitoring of vancomycin in serious methicillin-resistant Staphylococcus aureus infections in a multiethnic haemodialysis population. In addition, this study evaluated the impact of a dedicated pharmacy led therapeutic drug monitoring (TDM) service and the timing of vancomycin administration relative to haemodialysis on trough target attainment and maintenance in a haemodialysis unit with high permeability dialyzers.
Methods
We conducted a retrospective observational study of hospitalized haemodialysis patients receiving vancomycin between May 2020 and June 2023. Inpatient admissions were stratified into three sequential cohorts: pre protocol implementation, post protocol implementation with dedicated TDM pharmacist support and post protocol implementation without pharmacist TDM support. Primary outcomes included achievement of the therapeutic trough target (15–20 mg/L), loading and maintenance doses (mg/kg) and percentage time in therapeutic range.
Results
Among 563 inpatient admissions, implementation of the locally adapted weight based protocol resulted in mean loading doses closer to guideline recommendations (18.7 vs. 19.8 mg/kg; P=0.026) and significantly lower average maintenance doses (12.3 vs. 10.4 mg/kg; P=0.015). A higher proportion of admissions remained within the therapeutic range following protocol implementation, although differences were not consistently statistically significant. Removal of a dedicated TDM pharmacist did not attenuate improvements in loading or maintenance dosing and percentage time in therapeutic range was preserved. Intradialytic vancomycin administration was associated with lower trough concentrations and reduced likelihood of achieving therapeutic targets compared with post haemodialysis administration.
Conclusion
Adaptation of an international vancomycin therapeutic monitoring guideline to a local Singapore haemodialysis population achieved loading doses closer to recommended targets and improved maintenance dosing with sustained therapeutic exposure. These benefits persisted despite removal of dedicated pharmacist TDM oversight, highlighting the clinical value of a standardized, locally contextualized dosing protocol.