Background Efficacy of vancomycin in critical ill patients is highly related with adequate vancomycin blood levels, so a vancomycin protocol has been developed in a third-level hospital between the Pharmacy and the Intensive Care Unit (ICU) to achieve this goal. This protocol has been based on therapeutic vancomycin blood levels between 15 and 25 µg/ml, next day of the beginning of the protocol.
Purpose To assess if the protocol achieves adequate vancomycin blood levels the next day of the beginning of the loading dose, and propose any measures to improve the protocol.
Material and methods Prospective and descriptive study from 1 January to 31 May 31 2017, of every patient with vancomycin prescribed in the ICU unit. The patients included were separated by groups into different categories (sex, age, weight, body mass index (BMI), creatinine clearance (CrCl), and pathology). Subsequently, next-day level was analysed, and whether it was between therapeutic range (TR) (15–25 µg/ml) or not. Statistical significance was considered with p<0,10 because of the small sample in the study.
The protocol is as follows:
Results The study initially included 31 patients, of whom four were excluded because they did not strictly fit the protocol. Sixteen (59%) patients were male, median age was 52 (43–67) years and median CrCl was 98 ml/min (76–130), two patients had CrCl between 30 to 50 ml/min and none below 30 ml/min. Significant differences have been found in the categories of sex (p=0.012) and CrCl (p=0.09) through a one-way ANOVA. In 75.0% of males, the level found was below 15 µg/ml, in comparison to 27.3% in females. Of patients with CrCl >80 ml/min, 65% had a level below 15 µg/ml compared to 28.6% in the other groups.
Conclusion Because of the results found, at least males and patients with normal creatinine clearance are underdosed, but larger studies must be carried out. The recommendations to improve the protocol are to increase the dose of continuous perfusion in males and patients with CrCl >80 ml/min.
No conflict of interest
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