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Pharmacist-directed vancomycin therapeutic drug monitoring in pediatric patients: a collaborative-practice model

Kashif Hussain1, Rahila Ikram2, Gul Ambreen3

  • 1Department of Pharmacy, Aga Khan University Hospital, Aga Khan University Hospital, Stadium Road (Main Pharmacy), P.O Box 3500, Karachi, 74800, Pakistan. Kashif.hussain@aku.edu.

Journal of Pharmaceutical Policy and Practice
|December 1, 2021
PubMed

Insights

Pharmacist-directed therapeutic drug monitoring (TDM) for Vancomycin (VCM) significantly improved initial dosing and adjustments in pediatric patients. This optimized VCM therapy, enhancing patient care and reducing resistance risks.

Area of Science:

  • Pharmacology and Pharmaceutical Sciences
  • Pediatric Medicine
  • Clinical Pharmacy Practice

Background:

  • Therapeutic drug monitoring (TDM) of Vancomycin (VCM) is crucial in pediatrics to prevent antibiotic resistance, treatment failure, and toxicity.
  • Healthcare institutions often face challenges in implementing effective VCM-TDM services.
  • This study assessed a pharmacist-directed VCM-TDM service to overcome implementation barriers and optimize patient care.

Purpose of the Study:

  • To evaluate the impact of a pharmacist-directed VCM-TDM service on optimizing pediatric patient care.
  • To assess improvements in the prescribing of initial Vancomycin doses and subsequent dosage adjustments.
  • To analyze the effectiveness of a collaborative TDM model involving clinical and inpatient pharmacists.

Main Methods:

  • A quasi-experimental study involving pediatric patients (1 month-18 years) receiving intravenous VCM.
  • Phases included: pre-implementation (retrospective assessment), intervention (educational programs), and post-implementation (pharmacist-directed TDM).
  • Outcomes measured: optimal initial VCM doses, dosage adjustments, and VCM sampling time.

Main Results:

  • Significantly higher rates of correctly prescribed initial VCM doses were observed post-implementation (mean difference 0.22, p<0.0001).
  • Correct dosage adjustments also significantly increased post-implementation (mean difference 0.29, p<0.05).
  • Trends towards improved VCM-level timing were noted, though not statistically significant (p=0.079).

Conclusions:

  • Pharmacist-directed TDM services play a vital role in optimizing Vancomycin therapy in pediatric patients.
  • The implementation led to significant improvements in initial VCM dosing and dose adjustments.
  • This collaborative model enhances the quality of VCM therapeutic drug monitoring and patient outcomes.
Abstract

Keywords:
PediatricPharmacistTDMTherapeutic Drug MonitoringVancomycin

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