A targeted review of vancomycin use

In recent years vancomycin usage at the Ottawa Civic Hospital has been steadily increasing. In an effort to determine the reason for this resurgence, and whether or not it is justified, a prospective assessment of vancomycin utilization was performed. All new orders for vancomycin received in the pharmacy in a two-month period were evaluated against predetermined criteria for appropriate use, which were developed in conjunction with Infectious Diseases and Cardiac Surgery. Of the 55 orders evaluated during the study period, 32 (58.2%) were considered inappropriate, translating to a cost of approximately $5,500.00 for the seven-week period. Use of vancomycin in penicillin-allergic patients without a confirmed history of IgE-mediated reaction, was responsible for the majority of vancomycin prescribed unnecessarily (-66%). As a result of the review's findings, the following actions were taken by the Pharmacy and Therapeutics Committee: (1) vancomycin was restricted to specific indications; (2) vancomycin will be prospectively monitored by the Pharmacy Department; (3) physician education on approved indications and dosing of vancomycin; and (4) development of guidelines for assessment and prescribing in penicillin-allergic patients.