Vancomycin Utilization Evaluation: Are We Dosing Appropriately?

  • Ladan Ayazkhoo Department of Clinical Pharmacy, Faculty of Pharmacy,Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Unit, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Sarah Mousavi Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
  • Farnaz Ramazani Department of Clinical Pharmacy, Faculty of Pharmacy,Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Unit, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Maryam Ayatollahi-Tafti Department of Clinical Pharmacy, Faculty of Pharmacy,Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Unit, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Zeinab Sa’dabadi Department of Clinical Pharmacy, Faculty of Pharmacy,Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Unit, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mohammad Sistanizad Department of Clinical Pharmacy, Faculty of Pharmacy,Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pharmaceutical Care Unit, Emam Hossein Teaching and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Keywords: Vancomycin, Guideline, Weight, Dosing

Abstract

Background: Inappropriate use of vancomycin not only increase health care costs but also contribute to the emergence of resistant organisms. Higher trough serum vancomycin concentrations (>10mg/L) has been recommended for avoidance of development of resistance. We aim to compare the administered dose with recommended doses based on guideline-recommended weight-based dosing.Methods: In a cross sectional study, all patients who received vancomycin between July and October 2013, in infectious disease, internal medicine wards and emergency department of a teaching hospital in Tehran, Iran were entered to the study. Indication of vancomycin and necessary data for dose calculation including height and serum creatinine were recorded. Prescribed doses were compared with recommended doses in guidelines and calculated Glomerular filtration rate (GFR) for each patient.Results: One hundred and four patients (45 females and 59 males) recruited in the study. Our results indicated that, from all administered doses of vancomycin, 64.4% and 88.8% differs significantly (more than 20%) based on American Pharmacist Association (AphA) vancomycin monograph and guideline-recommended, weight-based vancomycin dosing (for adults), respectively.Conclusion: Underdosing of vancomycin is a major risk factor for developing resistance of gram positive organisms to this glycopeptide. Our results showed that more than half of patients receiving vancomycin are in the risk of low drug levels based on guidelines. So, having a comprehensive plan for the proper use of this drug especially designing effective internal guidelines can prevent emergence of resistance to vancomycin in future.

References

You JH, Lyon DJ, Lee BS, Kwan SM, Tang HY. Vancomycin utilization at a teaching hospital in Hong Kong. Am J Health Syst Pharm 2001; 58(22): 2167-9.

Hiramatsu K. Vancomycin-resistant Staphylococcus aureus: a new model of antibiotic resistance. Lancet Infect Dis 2001;1(3):147-55.

Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000; 342(10):710-21.

Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009; 66(1): 82-98.

Lacy F, GoldmanM, Lance L. Drug information handbook with international trade names index. American Pharmacists Association (APhA). USA: Lexicomp 22th edition. 2013-2014.

Drew R, Hooper D, Baron E.Vancomycin dosing and concentration monitoring in adults. In: D.S.Basow (ED.),Up To Date. Retrieved from http://www.uptodate.com/home/index.html.

Rybak MJ, Albrecht LM, Boike SC, Chandrasekar PH. Nephrotoxicity of vancomycin, alone and with an aminoglycoside. J Antimicrob Chemother 1990; 25(4): 679-87.

Rybak MJ, Abate BJ, Kang SL, Ruffing MJ, Lerner SA, Drusano GL. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother 1999; 43(7): 1549-55.

Lodise TP, Lomaestro B, Graves J, Drusano GL. Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Antimicrob Agents Chemother 2008; 52(4): 1330-6.

Vazin A, Japoni A, Shahbazi S, Davarpanah MA. Vancomycin utilization evaluation at hematology-oncology ward of a teaching hospital in iran. IJPR 2012; 11(1): 163-70.

Fahimi F, Soleymani F, Tavakoli-Ardakani M. Vancomycin Utilization Evaluation in a teaching hospital: A case- series study in Iran. J Pharm Care 2013; 1(2): 51- 4.

Roghmann MC, Perdue BE, Polish L. Vancomycin use in a hospital with vancomycin restriction. Infect Control Hosp Epidemiol 1999; 20(1): 60-3.

Hall RG 2nd, Hazlewood KA, Brouse SD, et al. Empiric guidelinerecommended weight-based vancomycin dosing and nephrotoxicity rates in patients with methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Pharmacol Toxicol 2013; 14(1): 12.

Hall RG 2nd, Giuliano CA, Haase KK, et al. Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Infect Dis 2012; 12(1): 104.

Published
2015-10-11
How to Cite
1.
Ayazkhoo L, Mousavi S, Ramazani F, Ayatollahi-Tafti M, Sa’dabadi Z, Sistanizad M. Vancomycin Utilization Evaluation: Are We Dosing Appropriately?. J Pharm Care. 1(4):149-152.
Section
Original Article(s)