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How vancomycin is used in Australasia--a survey
S B Duffull1, S T Chambers, E J Begg
1Clinical Pharamcology Department, Christchurch Hospital, NZ.
Australian and New Zealand Journal of Medicine
|December 1, 1993
Summary
Vancomycin dosing monitoring shows significant variability, particularly in when peak concentrations are measured. This inconsistency impacts therapeutic drug monitoring and patient outcomes.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Vancomycin serum concentration monitoring aims to optimize efficacy and minimize toxicity.
- Established guidelines suggest peak concentrations of 20-40 mg/L and trough concentrations of 5-10 mg/L.
- Significant variability exists in recommended timing for peak vancomycin concentration sampling.
Purpose of the Study:
- To investigate current practices in vancomycin dosing monitoring.
- To assess the extent of variability in clinical vancomycin therapeutic drug monitoring.
Main Methods:
- A survey was distributed to microbiology departments and infectious disease physicians in Australasian hospitals.
- Variability was analyzed using a two-compartment Bayesian model applied to mean recommendations.
- Data on peak and trough concentration targets and sampling times were collected.
Main Results:
- 86% of respondents routinely monitored vancomycin concentrations.
- Target peak concentrations (20-40 mg/L) and trough concentrations (< or = 10 mg/L) were frequently pursued.
- Peak concentration sampling times varied widely (median 30 minutes post-infusion), leading to predicted peak concentrations ranging from 30 to 86 mg/L.
Conclusions:
- Considerable variation exists in vancomycin therapeutic monitoring practices.
- The timing of peak concentration sampling is a primary driver of this variability.
- Inconsistent monitoring significantly affects vancomycin dosing and therapeutic outcomes.