Vancomycin Utilization Review in Patients Undergoing Bone MarrowTransplantation
Background: Infections in neutropenic patients are considered as major causes of mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation (BMT) patients.
Methods: In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses.
Results: Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation (56.9%, 43.1%). About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network (NCCN) guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0±11.9 μg/mL.
Conclusion: Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug.
Newman MJ, Frimpong E, Donkor ES, Opintan JA , Asamoah-Adu A. Resistance to antimicrobial drugs in Ghana. Infect Drug Resist 2011; 4: 215–220.
Al Za’abi M, Shafiq S, Al Riyami D , Ali BH. Utilization Pattern of Vancomycin in a University Teaching Hospital in Oman: Comparison with International Guidelines. Tropical Journal of Pharmaceutical Research 2013;12:117-21.
Griffith RS. Introduction to vancomycin. Rev Infect Dis 1981;3 suppl:S200-4.
Vazin A, Japoni A, Shahbazi S ,Davarpanah MA. Vancomycin Utilization Evaluation at Hematology-Oncology Ward of a Teaching Hospital in Iran. IJPR 2012;11:163-70.
Entenza J, Veloso T, Vouillamoz J, Giddey M ,Moreillon P. Failure of vancomycin continuous infusion against experimental endocarditis due to vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother 2011;55:385-7.
Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Therapeutic Monitoring of Vancomycin in Adults. Pharmacotherapy 2009;29:1275-9.
Fahimi F, Baniasadi S, Behzadnia N, Varahram F, Ghazi Tabatabaie L. Enoxaparin utilization evaluation: An observational prospective study in medical inpatients. IJPR 2010; 7:77-82.
American Society of Health-System Pharmacists. ASHP guidelines on medication-use evaluation. Am J Health-Syst Pharm 1996; 53:1953–5.
Tavakoli-Ardakani M, Eshraghi A, HajhosseinTalasaz A, Salamzadeh J. A Drug Utilization Evaluation Study of Amphotericin B in Neutropenic Patients in a Teaching Hospital in Iran. IJPR 2012;11:151-6.
Freifeld A, Bow E, Sepkowitz K, et al. Wingard. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56–e93
Wood AJ, Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. New Engl J Med 1993; 328:1323-32.
LaPlante KL, Leonard SN, Andes DR, Craig WA, Rybak MJ. Activities of clindamycin, daptomycin, doxycycline, linezolid, trimethoprimsulfamethoxazole, and vancomycin against community-associated methicillin-resistant Staphylococcus aureus with inducible clindamycin resistance in murine thigh infection and in vitro pharmacodynamic models. Antimicrob Agents Chemother 2008; 52:2156-62.
Moise-Broder PA, Sakoulas G, Eliopoulos GM, et al. Accessory gene regulator group II polymorphism in methicillin-resistant Staphylococcus aureus is predictive of failure of vancomycin therapy. Clin Infect Dis 2004; 38:1700-5.
|Issue||Vol 2, No 2 (Spring 2014)|
|Vancomycin Febrile neutropenia Drug Utilization ReviewBone Marrow Transplantation|
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