Investigating vancomycin dosing during a patient's transition from intermittent dosing to continuous infusion

Abstract

AbstractAimTo investigate vancomycin dosing during the transition from intermittent dosing (ID) to continuous infusion (CI) in preparation for discharge on infuser bottles.MethodsPatients discharged with vancomycin infuser bottles (01/01/11 to 31/12/13) were identified from pharmacy dispensing software. Data including demographics, microbiology, dosing and plasma concentrations were analysed using Microsoft Excel. Dosing was compared against current guidelines.ResultsTwenty patients had switched from ID to CI and were discharged on infuser bottles. At initiation of ID 65% (13/20) were started on total daily doses (TDD) that reflected guidelines. At the switch, 50% (10/20) were at steady state and 30% (6/20) were known to have therapeutic plasma concentrations. When switched to CI, 50% (10/20) were started on a dose that matched the TDD received during ID, while 30% (6/20) were switched to a lower — and 20% (4/20) to a higher — CI starting dose. At discharge 60% (12/20) of patients recorded therapeutic plasma concentrations; 30% (6/20) of patients remained on a CI dose that was equal to the TDD received prior to switching and 45% (9/20) had a decreased dose; while 25% (5/20) had their doses increased. Compared to current guidelines, 65% (13/20) were receiving a lower than recommended TDD. Patients stabilised on a CI for at least 72 h before discharge were less likely to require dose changes post‐discharge.ConclusionThe TDD recommended in current guidelines for ID may not reflect the patients’ needs when prescribing a CI. Lower than recommended doses are more often required. Stabilising CI dosing prior to discharge can improve outpatient treatment by reducing post‐discharge dosage changes.