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Are vancomycin dosing guidelines followed? A mixed methods study of vancomycin prescribing practices
Jane E Carland1,2,3, Sophie L Stocker1,2,4, Melissa T Baysari5
1Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.
British Journal of Clinical Pharmacology
|March 26, 2021
Summary
Vancomycin dosing and therapeutic drug monitoring (TDM) often do not follow guidelines. Improved strategies are needed to ensure optimal vancomycin use and patient safety.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- International consensus guidelines exist for vancomycin dosing and therapeutic drug monitoring (TDM).
- Suboptimal vancomycin dosing and TDM practices are prevalent despite guideline availability.
- Understanding prescriber decision-making is crucial for improving vancomycin therapy.
Purpose of the Study:
- To assess the concordance of vancomycin dosing and TDM with institutional guidelines.
- To identify factors influencing clinicians' vancomycin prescribing decisions.
- To evaluate the effectiveness of guidelines in clinical practice.
Main Methods:
- Retrospective audit of 163 patients receiving vancomycin therapy (≥48 hours).
- Collection of patient characteristics, dosing history, and plasma vancomycin/creatinine concentrations.
- Semi-structured interviews with 17 prescribers, including simulated prescribing scenarios.
Main Results:
- Only 24% of vancomycin courses started with a recommended loading dose; 72% were lower than recommended.
- Initial maintenance doses were concordant in 42% of courses, with 34% lower than recommended.
- Dose adjustments were infrequent for sub- or supratherapeutic trough vancomycin concentrations; only 14% of TDM samples were troughs.
Conclusions:
- Poor compliance with institutional vancomycin guidelines was observed among prescribers.
- Prescriber awareness of guidelines did not translate to consistent adherence.
- Multifaceted strategies are necessary to enhance vancomycin dosing and TDM practices.
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