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PKP-011 Pharmacotherapeutics monitoring analysis of vancomycin in the pharmaceutical service
  1. R Miranda,
  2. I Ratão,
  3. F Dimas,
  4. A Guimarães,
  5. V Barradas,
  6. A Gaspar
  1. Centro Hospitalar Barreiro Montijo, Pharmacy, Barreiro, Portugal


Background Vancomycin is a widely used antibiotic in nosocomial infections due to methicillin-resistant staphylococcal aureus, a major cause of death, justifying the strict controls on its use as well as serum drug level monitoring (SDLM).

Purpose To evaluate pharmaceutical interventions regarding their impact on the initial regimen and adjustment of serum vancomycin levels.

Material and methods A retrospective observational study of patients for whom pharmacokinetic monitoring of vancomycin was requested in the year 2013. The parameters evaluated were obtained from the computer applications Kinetidex, Clinidata Net and the pharmacotherapeutic profile: creatinine, dose, first dosed serum drug level and suggested dose.

Results 433 serum drug levels of vancomycin were determined. Of the total 159 patients, 63.5% were subjected to pharmacokinetic monitoring, averaging 4.29 serum drug levels per patient.

61.4% patients received vancomycin, in an intermittent regimen (IR), 38.6% received it by continuous infusion (CI), of these only 46.2% had a loading dose.

The average trough serum drug level was 14.07 μg/ml and the intermediate serum drug level in the CI regimen was 23.14 µg/ml.

It was found that 40% of the trough serum drug levels in the IR were within the reference values?? (RV) (10–15 µg/ml), 30% of serum drug levels were above and 30% were below.

In CI, 13.9% of intermediate serum drug levels were within the RV (20–25 µg/ml), 33.3% were above and 52.7% were below.

Most pharmaceutical interventions were aimed at maintaining the dosing interval, reflecting the interventions in increasing doses (31.68%) or decreasing doses (20.79%).

Conclusion It was concluded that many patients required an adjustment to the initial treatment regimen, maintaining the dosing interval, but with dose modifications.

A serum drug level lower than the RV is not effective in controlling the infection with the potential emergence of resistant strains. High serum drug levels above the RV may cause toxic effects.

This differentiated pharmaceutical intervention contributed to improved health outcomes and strengthened the regulatory framework in multidisciplinary health teams.


  1. Murphy JE, Clinical pharmacokinetics. American Society of Health-System Pharmacists, 3rd ed. 2005:349–64

ReferenceNo conflict of interest.

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