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The appropriateness of initial vancomycin dosing
D P Rodman1, J T McKnight, T Rogers
1Department of Clinical Pharmacy, School of Pharmacy, Auburn University, Alabama.
Background:
Vancomycin use has markedly increased over the past several years because of an increased incidence of resistant organisms, particularly methicillin-resistant Staphylococcus aureus. Despite the availability of dosing nomograms and the use of peak and trough levels, vancomycin dosing has remained problematic.
Methods:
All intravenous vancomycin orders over a 3-month period in a community and teaching hospital were screened for appropriateness of initial dosing based on available dosing nomograms.
Results:
Of the 48 patients who received intravenous vancomycin, only 19 (39.6%) were given initial doses that achieved the desired serum concentration. There were no significant differences in the appropriateness of initial dosing between family medicine residents, attending physicians, and private staff physicians. Older patients in our study were at higher risk for overdosing, whereas younger patients were more likely to be underdosed. In this study, nomogram use could have yielded correct initial dosages in 40 of the 48 patients (83.3%).
Conclusions:
Our study indicates a high percentage of inappropriate initial vancomycin dosing in a community and teaching hospital. The investigators believe inappropriate initial vancomycin dosing is common and may result in unnecessary expense, increased risk of therapeutic failures, and greater potential for adverse drug reactions. Increased use of vancomycin dosing nomograms could improve the rate of correct initial dosages.
Insights
Initial vancomycin dosing is frequently inappropriate, leading to potential treatment failures and adverse events. Utilizing vancomycin dosing nomograms could significantly improve initial dose accuracy in hospitals.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Vancomycin use has increased due to rising rates of resistant bacteria, such as MRSA.
- Despite available tools, vancomycin dosing remains challenging for clinicians.
Purpose of the Study:
- To evaluate the appropriateness of initial intravenous vancomycin dosing in a hospital setting.
- To assess the impact of nomogram use on achieving target vancomycin serum concentrations.
Main Methods:
- A 3-month retrospective review of all intravenous vancomycin orders.
- Screening of orders for initial dose appropriateness based on established nomograms.
Main Results:
- Only 39.6% of patients received appropriate initial vancomycin doses.
- Nomogram use could have corrected initial dosing in 83.3% of cases.
- Age influenced dosing appropriateness, with older patients at risk of overdose and younger patients of underdose.
Conclusions:
- A high rate of inappropriate initial vancomycin dosing exists in community and teaching hospitals.
- Incorrect dosing can lead to increased costs, therapeutic failures, and adverse drug reactions.
- Wider adoption of vancomycin dosing nomograms is recommended to enhance dosing accuracy.