Drug Utilization Evaluation of Vancomycin in a Referral Infectious Center in Mazandaran Province

  • Ebrahim Salehifar Mail Associate Professor of Clinical Pharmacy, Department of Clinical Pharmacy, Faculty of Pharmacy, Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
  • Farhang Babamahmoodi Associate Professor of Infectious and Tropical Diseases, Antimicrobial Resistance Center, Department of Infectious Diseases, Razi Hospital, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
  • Ahmad Alikhani Assistant Professor of Infectious and Tropical Diseases, Razi Hospital, Department of Infectious Diseases, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
  • Reza Ganji Resident of Clinical Pharmacy, Students Research Committee, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
  • Mehran Fazli Students Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari. Iran.
Keywords:
Vancomycin, Drug Utilization Evaluation, Drug Resistance

Abstract

Background: DUE (Drug Utilization Evaluation) studies can help identify and correct problems associated with irrational use of drugs. Considering lack of data regarding how rational vancomycin is being used, we evaluated this DUE study in a referral infectious center to evaluate compliance with guidelines in terms of rational use of this valuable antibiotic.
Methods: This retrospective study was done for 6 months from March to September 2012 at Razi hospital, an educational hospital affiliated to Mazandaran University of Medical Sciences. Data including patients’ demographics, vancomycin dose, kidney function assessment, dose adjustments, sampling and culture were collected. Based on the HICPAC (Hospital Infection Control Practices Advisory Committee) and Up-to-date 2012 advices, the concordance of practice with standard guidelines was assessed.
Results: One hundred and forty six medical records were reviewed in this study. Fever and shortness of breath were the most common symptoms at the time of initiation of vancomycin. Skin infections, lower respiratory tract infection and septicemia were the most common initial diagnosis of patients. Sampling was done in almost one-third of patients. Most of patient with a specific order were received vancomycin in half an hour. Considering the indication, Vancomycin was administered appropriately in 58 percent of patients.
Conclusion: Vancomycin was used irrationally in a great proportion of patients. The main observed drawbacks were empiric use of vancomycin without subsequent adjustment of antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to calculation of creatinine clearance and dosage adjustment.

References

Michel M, Gutmann L. Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci: therapeutic realities and possibilities. Lancet 1997;349(9069):1901-6.

Cormican MG, Jones RN. Emerging resistance to antimicrobial agents in gram-positive bacteria. Enterococci, staphylococci and nonpneumococcal streptococci. Drugs 1996; 51 (Suppl. 1):6-12.

Butler JC, Hofmann J, Cetron MS, et al. The continued emergence of drugresistant Streptococcus pneumoniae in the United States: an update from the Centers for Disease Control and Prevention’s Pneumococcal Sentinel Surveillance System. J Infect Dis 1996; 174(5):986-93.

Pace JL, Yang G. Glycopeptides: Update on an old successful antibiotic class. Biochem Pharmacol 2006;71(7):968-80.

Crisostomo MI, Westh H, Tomasz A, et al. The evolution of methicillin resistance in Staphylococcus aureus: similarity of genetic backgrounds in historically early methicillin-susceptible and resistant isolates and contemporary epidemic clones. Proc Natl Acad Sci U S A 2001;98(17): 9865-70.

Wood AJ, Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. New Engl J Med 1997;336(10):708-16.

National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000;28(6):429-48.

Salgado CD, Farr BM. Outcomes associated with Vancomycin-resistant enterococci: a meta-analysis. Infect Control Hospital Epidemiol 2003;24(9):690-8.

Appelbaum P. The emergence of Vancomycin-intermediate and Vancomycinresistant Staphylococcus aureus. Clin Microbiol Infect 2006;12(s1):16-23.

Recommendations for preventing the spread of Vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control 1995; 44(RR-12):1-13.

Nadzam DM. Development of medication-use indicators by the Joint Commission on Accreditation of Healthcare Organizations. Am J Hosp Pharm 1991;48(9):1925-30.

Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47(3):533-43.

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.

Alfandari S, Levent T, Descamps D, et al. Evaluation of glycopeptide use in nine French hospitals. Med Mal Infect 2010;40(4):232-7.

Wright SW, Wrenn KD. Appropriateness of Vancomycin use in the emergency department. Ann Emerg Med 1998;32(5):531-6.

Melo DO, Sasaki M, Grinbaum RS. Vancomycin use in a hospital with high prevalence of methicillin-resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC). Braz J Infect Dis 2007;11(1):53-6.

Askarian M, Assadian O, Safaee G, et al. Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003. East Mediterr Health J 2007;13(5):1195-201.

Khalili H, Gholami K, Hajiabdolbaghi M, Sairafipoor Z. Vancomycin Drug Utilization Evaluation in infectious disease ward of Imam Khomeini Hospital. TUMJ 2007;64(12): 64-8

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): 51-54

Ayazkhoo L, Mousavi S, Ramazani F, Ayatollahi-Tafti M, Sa’dabadi Z, Sistanizad M. Vancomycin Utilization Evaluation: Are We Dosing Appropriately? J Pharm Care 2013; 1(4): 149-152.

Rossi S. Australian medicines handbook 2013: Australian Medicines Handbook; 2013.

Polk RE, Healy DP, Schwartz LB, Rock DT, Garson ML, Roller K. Vancomycin and the red-man syndrome: pharmacodynamics of histamine release. J Infect Dis 1988;157(3):502-7.

Spruill WJ, Wade WE, Cobb HH, 3rd. Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Am J Geriatr Pharmacother 2008;6(3):153-60.

Cappelletty D, Jablonski A, Jung R. Risk Factors for Acute Kidney Injury in Adult Patients Receiving Vancomycin. Clin Drug Investig 2014;34(3): 189-93.

Ena J, Dick RW, Jones RN, Wenzel RP. The epidemiology of intravenous Vancomycin usage in a university hospital. JAMA 1993; 269(5): 598-602.

Published
2015-10-11
How to Cite
1.
Salehifar E, Babamahmoodi F, Alikhani A, Ganji R, Fazli M. Drug Utilization Evaluation of Vancomycin in a Referral Infectious Center in Mazandaran Province. J Pharm Care. 2(2):55-59.
Section
Original Article(s)