Background Vancomycin is an anti-gram positive antibiotic with a narrow therapeutic index which is used widely for the treatment of nosocomial infections.

Purpose The aim of the study was to evaluate the impact of pharmacist interventions on vancomycin dosing and nephrotoxicity prevention

Material and methods This was a comparative study performed in our hospital between 1 June and 30 September. 200 adult patients undergoing vancomycin therapy were included. Half of the patients received pharmacist intervention and half of patients received routine medical care without pharmacist involvement. The pharmacists’ interventions included: initial dosage determination, therapeutic drug monitoring and monitoring of kidney function. The 2 groups were compared to evaluate the outcome of pharmacist intervention.

Results In the pharmacist intervention group, trough plasma concentration of vancomycin was measured in all patients, whereas in the non-pharmacist intervention group, vancomycin level was checked only in 40% of patients. The percentage of trough concentrations within the therapeutic range was significantly higher in the pharmacist intervention group, 62 versus 41% (p<0.05). The incidence of nephrotoxicity was significantly lower in the pharmacist intervention group, 28 versus 16% (p<0.05).

Conclusion Pharmacist intervention may improve optimal dosing of vancomycin and decrease the incidence of acute kidney injury concomitantly.

References and/or acknowledgements

1. Obin C M, et al. Vancomycin therapeutic drug monitoring: is there a consensus view? The results of a UK National External Quality Assessment Scheme (UK NEQAS) for Antibiotic Assays questionnaire. J Antimicrob Chemother2002;50:713–18.

2. Ye ZK, Li C, Zhai SD. Guidelines for therapeutic drug monitoring of vancomycin: a systematic review. PLOS One2014;9:e99044.

References and/or acknowledgementsNo conflict of interest