Background Therapeutic drug monitoring is an important means of optimising drug utilisation and doses for the purpose of improving clinical effectiveness.

Purpose To assess compliance of vancomycin and aminoglycosides pharmacokinetic monitoring requests with the trust standardised request criteria.

Material and methods Prospective observational study (1 March 2015 to 1 April 2015). Serum level monitoring was appropriate if the patients fulfilled at least one of the following criteria: age >65 years, prolonged antibiotic treatment (over 7 days), critical patient, renal function (eFGR <30 mL/min) and concomitant administration of nephrotoxic agents. Other data collected included gender and admission unit.

Results 169 patients were included. Vancomycin was prescribed to 67 of these patients, whereas 98 were receiving aminoglycosides (40 on tobramycin, 27 on amikacin and 31 on gentamicin); 4 patients were receiving both. Among the 115 patients (68.04%) who fulfilled the criteria for kinetic monitoring, the reasons for this were: age >65 years (52.17%) and antibiotic treatment over 7 days (35.65%). However, only in 46.95% of the cases was the request submitted to the pharmacy. According to the requesting unit/department, 31.4% were from intensive care, followed by internal medicine (29.6), neurosurgery (9.25%) and paediatrics (9.25%).

Conclusion This study revealed that approximately two-thirds of patients in our trust receiving vancomycin and aminoglycoside therapy would benefit from kinetic monitoring, as defined above. Nonetheless, antibiotic drug level monitoring and dose adjustment were barely requested in half of those cases. This low rate, alongs with the narrow therapeutic range of these drugs, suggests that antibiotic therapy could be optimised. Pharmacy led activities, such as educational sessions aimed at raising awareness of the importance of drug level monitoring, may play a role in improving the use of this service.

No conflict of interest.