Vancomycin trough level and loading dose Felipe Francisco Tuon,1 Rudson Romero,2 Juliano Gasparetto,2 Juliette Cieslinski1 1Laboratory of Microbiology and Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; 2School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, BrazilDear editorWe read with interest the paper by Barceló-Vidal et al1 about vancomycin nephrotoxicity due to high trough levels with histopathology. The authors described a case developing both lesions and described total vancomycin washout after a biopsy-proven vancomycin toxicity. Unfortunately, most patients receiving the loading dose of >25 mg/kg do not achieve adequate trough level, which was recommended by some guidelines to be between 15 and 20 mg/L.2 Considering this issue, we performed a brief study in two Brazilian hospitals with therapeutic drug monitoring (TDM) of vancomycin and loading dose of 30 mg/kg. The inclusion criteria for the retrospective observational study were as follows: patients were aged >18 years, admitted to an intensive care unit (ICU), with infection, and received at least 72 hours of vancomycin, with the creatinine level of