Implementing a Standard Operating Procedure Is Associated with Improved Vancomycin Target Attainment in Bone and...

Area of Science:

• Pharmacology and Infectious Diseases
• Clinical Pharmacy Practice
• Orthopedic Surgery

Background:

• Intravenous vancomycin is crucial for treating orthopedic infections like prosthetic joint infections and osteomyelitis.
• Current real-world vancomycin dosing often fails to achieve desired pharmacokinetic/pharmacodynamic (PK/PD) targets.
• Optimizing vancomycin dosing is essential for effective treatment and minimizing toxicity in orthopedic patients.

Purpose of the Study:

• To evaluate if a ward-embedded standard operating procedure (SOP) enhances vancomycin target attainment and dosing efficiency.
• To assess the impact of the SOP on achieving therapeutic vancomycin trough concentrations (15-20 mg/L).
• To determine if the SOP reduces sub- and supratherapeutic vancomycin exposures and the number of dose adjustments.

Main Methods:

• A single-center, non-randomized pre-post study was conducted in an orthopedic service.
• The SOP mandated weight-adapted loading doses, renal function-adjusted maintenance doses, a 15-20 mg/L trough target, and scheduled therapeutic drug monitoring (TDM).
• Data from 154 adult patients receiving vancomycin for ≥72 hours were analyzed, comparing pre-SOP (retrospective) and post-SOP (prospective) periods.

Main Results:

• Implementation of the SOP led to 100% use of weight-based loading doses, compared to 31.0% previously.
• The proportion of vancomycin troughs within the target range increased from 28.2% to 41.7% post-SOP.
• Time to first in-range trough significantly shortened (median 4 to 2 measurements), and mean dose adjustments per patient decreased from 4.0 to 2.48.

Conclusions:

• A pragmatic, ward-embedded SOP for intravenous vancomycin significantly improved pharmacologic precision in orthopedic care.
• The protocol resulted in more measurements within the target range, fewer subtherapeutic exposures, and faster attainment of therapeutic levels.
• These findings support the adoption of protocol-first implementation for consistent vancomycin exposure in orthopedic settings.