Background Up to 50% of antibiotic treatments prescribed have been estimated to be incorrect.1 This is probably caused by the high level of knowledge required for the appropriate use. Training may be a way to improve antibiotic use.
Purpose To analyse the impact of training on the correct use of trough vancomycin plasma concentrations as a tool for monitoring effectiveness and safety in a teaching hospital.
Material and methods The training was conducted by disseminating local antibiotic guidelines including the recommendations contained in the consensus document on therapeutic monitoring of vancomycin.2 A before-after study was conducted comparing before the training period (January–April 2012) with a later period (September–December 2013). We selected patients treated with vancomycin and we collected data on duration and concomitant treatment, demographic variables, serum creatinine before and during treatment. Creatinine clearance was calculated by MDRD-4, considering impaired renal function ?? <80 ml??/min. To compare the two periods the McNemar-Bowker test (SPSS v.15) was used.
Results 85 patients were treated with intermittent infusion of vancomycin, 30 patients before vs. 45 after the training. The median age was 66 vs. 65 years. Mostly men, 70% vs. 55.6%. Median days of treatment were 7 [7 (1–46) vs. 7 (1–24)]. No levels were requested in 90% vs. 73.3% for the two periods, which met one or more criteria; monitoring was 63% vs. 51.1%, no statistically significant difference (p = 0.379). The criterion of more than five days duration was 100%; monitoring was 86.9% in both periods.
Conclusion The implementation of an educational activity did not meet expectations in terms of an increase in adherence to recommendations. It is necessary to intensify these training activities and the role of the clinical pharmacist on the usefulness and advantages of monitoring vancomycin, particularly during prolonged treatment.
References and/or Acknowledgements
Dellit TH. Clin Infect Dis.
Rybak M. Am J Health Syst Pharm
References and/or AcknowledgementsNo conflict of interest.
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