Evaluation of Vancomycin Administration After Pharmacist Intervention in the Intensive Care Unit of an Educational Hospital

Abstract

Background: Vancomycin is a glycopeptide antibiotic used to treat infections caused by Gram-positive bacteria. Irrational administration of this antibiotic may result in increased morbidity or mortality due to toxicity and the emergence of resistant organisms and also impose additional costs. Objectives: The current study aimed at evaluating the effect of pharmacist intervention on vancomycin administration, and discussing appropriate and inappropriate applications of this drug. Methods: The current study was performed on all patients receiving vancomycin intravenously in the intensive care unit (ICU) of Loghman educational Hospital in Tehran, Iran, from May to September 2015. Relevant data were collected by a pharmacist from each patient and their datasheets such as medical records, patient’s history, medical orders, nursing reports, and the experimental results available in the patient’s records, duration of vancomycin use, history of drug allergy, first diagnoses, type of administration, monitoring necessity, dosing regimen, and occurrence of adverse drug reaction. Patients then were followed until discharge from ICU. Results: About 82% of patients had received vancomycin without noticing their body mass index (BMI) or calcium-induced calcium release (CICR). In addition, 2.63% had inappropriate indication, and in general, the duration of therapy was somehow correct in 44.73% of patients, and 55.26% received vancomycin for more than the appropriate period. Most of the wrong administration was for postoperative prophylaxis. The appropriate duration is maximum 48 hours. But in 63.33% of the patients, it continued for more than 2 - 3 days. And this inappropriate usage could increase vancomycin resistance. Conclusions: Due to the increasing resistance rate to antibiotics, indication and duration of administration and dosing should be more accurate, and for each patient must be according to his/her ideal body weight (IBW).