Short term impact of guidelines on vancomycin dosing and therapeutic drug monitoring

Swartling, Maria; Gupta, Rishu; Dudas, Vicky; Guglielmo, B. Joseph

doi:10.1007/s11096-012-9614-6

Cited by 37 publications

(46 citation statements)

References 8 publications

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“…Utilizing different approaches such as education or pharmacist-managed dosing and monitoring services has shown increased adherence to protocols, the achievement of therapeutic serum vancomycin concentrations and a reduction in the rates of nephrotoxicity and the emergence of resistance [6,7]. The use of a loading vancomycin dose is not addressed in the guidelines of many hospitals [8].…”

Section: Discussionmentioning

confidence: 99%

Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring

Momattin¹,

Zogheib²,

Homoud³

et al. 2015

Chemotherapy

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Background: Therapeutic vancomycin trough levels correlate with therapeutic success and the development of renal failure. In this study, we aimed to describe the safety and outcome of pharmacy-led vancomycin dosing and monitoring. Methods: We included adults requiring vancomycin for >48 h and who had a vancomycin trough level drawn near steady state. The primary outcome of the comparison was the achievement of therapeutic trough levels, defined as 10-20 µg/ml. Secondary outcome included acute renal failure. We compared these outcomes before and after the implementation of pharmacy-led vancomycin dosing and monitoring. Result: During the study period, a total of 278 patients were in the preimplementation phase and 286 were in the postintervention phase. There was a clear increase in the percentage of patients achieving the therapeutic range (50.5 vs. 79.7%, p = 0.0001) and an increase in the percentage of levels within the therapeutic range (31.6 vs. 59.1%; p = 0.0001). The number of cases receiving vancomycin increased by 5% and the duration of therapy decreased by 19.5%. More patients attained a therapeutic range of 10-20 µg/ml (i.e. the level was 31.6% in the preintervention and 59.1% in the postintervention phase). Conclusions: A higher percentage of patients achieved a therapeutic range and less nephrotoxicity when using a pharmacy-led protocol for vancomycin dosing.

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Section: Discussionmentioning

confidence: 99%

Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring

Momattin¹,

Zogheib²,

Homoud³

et al. 2015

Chemotherapy

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“…To improve the quality of vancomycin TDM, several organizations have developed clinical practice guidelines (CPGs) for appropriate vancomycin TDM. More patients have appropriate trough concentration measurement and sample timing when the guideline is followed [3]. However, many studies suggest that significant numbers of patients do not achieve therapeutic vancomycin serum concentrations [4]–[13].…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Therapeutic Drug Monitoring of Vancomycin: A Systematic Review

Zhai

2014

PLoS ONE

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Background and ObjectiveDespite the availability of clinical practice guidelines (CPGs) for therapeutic drug monitoring (TDM) of vancomycin, vancomycin serum concentrations still do not reach therapeutic concentrations in many patients. Thus, we sought to systematically review the quality and consistency of recommendations for an international cohort of CPGs regarding vancomycin TDM.MethodsPubMed, Embase, guidelines' websites and Google were searched for CPGs for vancomycin TDM. Two independent assessors rated the quality of each CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREEII) instrument and data were independently extracted.ResultsTwelve guidelines were evaluated and the overall quality of guidelines for vancomycin TDM was moderate. The highest score was recorded in the domain of clarity of presentation, and the lowest score was recorded in the domain of rigor of development and stakeholder involvement. The specific recommendations for vancomycin TDM were moderately consistent and guidelines varied in trough concentration monitoring, frequency of TDM, and serum concentration targets.ConclusionThe overall guideline quality for vancomycin TDM was not optimal and effort is needed to improve guideline quality, especially in the domain of rigor of development and stakeholder involvement.

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“…[2] Regarding to increasing the number of critically ill patients at high risk for MRSA colonization and infection, vancomycin utilization has been increased. [5] As a result, serious adverse effects of increased and inappropriate vancomycin utilization considered a great dilemma in health systems not only for financial and adverse reaction problems but also for limited options for treatment. [6789]…”

Section: Introductionmentioning

confidence: 99%

A new approach to Vancomycin utilization evaluation: A cross-sectional study in intensive care unit

2016

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Objective:The risk of methicillin-resistant Staphylococcus aureus infections in Intensive Care Unit (ICU) is increasing in recent years with high rate of morbidity and mortality. Therefore, in this study, we aimed to evaluate the rationale use of vancomycin in ICU patients.Methods:A total of 200 patients who received at least 48 h intravenous vancomycin were randomly selected from ICU wards, during 9 months. Vancomycin administration and related clinical and laboratory data were gathered from patients' charts and health information system to evaluate the appropriateness of different aspects of vancomycin use during all days which vancomycin were ordered.Findings:During the study, 15,230 ± 1216 mg (mean ± standard error of the mean [SEM]) vancomycin was administered for 200 patients in the mean period of 9.79 ± 0.64 (SEM) days of ICU stay, for prophylaxis and empiric therapy. Results showed the appropriateness of vancomycin uses were 30.5%, 9%, and 5.5% in the first 24 h, after 72 h and during the whole time of treatment, respectively. In addition, infectious consultation was the only significantly different parameter between appropriate and inappropriate vancomycin administration groups (P < 0.001).Conclusion:Although vancomycin utilization evaluation were mentioned in previous studies, but data related to ICU patients and during all days of vancomycin therapy are limited. High prevalence of inappropriate use of vancomycin in ICU is alarming for health systems and necessitates implementation of antibiotic policies.

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Short term impact of guidelines on vancomycin dosing and therapeutic drug monitoring

Cited by 37 publications

References 8 publications

Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring

Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring

Guidelines for Therapeutic Drug Monitoring of Vancomycin: A Systematic Review

A new approach to Vancomycin utilization evaluation: A cross-sectional study in intensive care unit

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