Background In 2009 we established a consensus review of therapeutic monitoring of vancomycin by several societies including the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA) and the Society of Infectious Diseases Pharmacists (SIDP).
Purpose To study the use of plasma concentrations (PCs) as a tool for monitoring the effectiveness and safety of vancomycin treatment; follow-up of the changes made in response to the recommendations made.
Materials and Methods Retrospective descriptive study in a tertiary hospital during the first four months of 2012. Vancomycin trough plasma concentrations (PCs) were collected. The laboratory service requested and identified patients treated with vancomycin in the unit dose dispensing system. An automatic system recorded the doses, days of treatment indicated, glomerular filtration rate (GF) prior to and during treatment with vancomycin (calculated by the MDRD formula, considering renal function impairment (RFI) lower GFR 80 ml/min) and concomitant treatment. The recommendations contained in the consensus document on vancomycin therapeutic monitoring of the Infectious Diseases Society of America (IDSA) and the American Society of Health-System Pharmacists (ASHP) were used as the standard criteria for vancomycin PC monitoring: RFI, treatment for more than five days or concomitant nephrotoxic drug administered.
Results 30 patients were enrolled, median age 66, 21 men, median treatment duration of 7 (1–46) days. The PC was checked in 10% (3) of the patients, two had PCs within the recommended values. In the third patient a single plasma level was requested, which revealed less than the recommended values but the same dose and schedule was maintained throughout the 29 days of treatment. In none was the area under the curve divided by the minimum inhibitory concentration (AUC/MIC) reported, the pharmacokinetic parameter best related to the effectiveness of vancomycin. Plasma levels were not requested in 27 patients, 90% of the total treated with vancomycin. 63% met one or more criteria for monitoring; treatment for longer than five days was the most common criterion (20). In one patient the recommendations made were acted on.
Conclusions The established recommendations on therapeutic monitoring of vancomycin are not being applied in our hospital.
A high number of patients treated with vancomycin did not use the PC as a parameter with which to monitor the efficacy and safety of antibiotic treatment.
One possible cause could be a lack of training of medical staff on the usefulness and benefits of vancomycin monitoring, particularly during prolonged treatment and in patients with RFI.
No conflict of interest.
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