Survey on the Use of Gentamicin and Vancomycin in Adult Intensive Care Units

Abstract

Aminoglycosides and glycopeptides are frequently used as empirical antibiotics in critically ill patients. Various nomograms are employed to monitor and adjust doses either as once daily or more frequent regimens. However, there is no universal guidance for their administration and monitoring. We conducted a survey, using an online questionnaire, of adult intensive care units (ICUs) across England, Wales and Northern Ireland, to ascertain prescribing and monitoring practices. ICUs listed on the Intensive Care National Audit and Research Centre (ICNARC) register were invited to participate. A total of 242 intensive care units were approached and 24.3% responded (n=59). Of those responding, 100% (n=59) used gentamicin to treat gram-negative infections, with 96.6% (n=57) of them using a once daily regimen and 11.9% (n=7) using multiple doses daily. An initial gentamicin dose of 5mg/kg was used by 53.4% (n=31), whereas 25.9% (n=15) used a concentration of 7 mg/kg. With regard to use of glycopeptides, vancomycin was used by 83.1% (n=49) of responders while 61% (n=36) used teicoplanin. Over two-thirds of responders (67.3%, n=35) indicated that they used vancomycin as an intermittent daily dose and 32.7% (n=17) used it as a continuous infusion. We conclude that diversity exists as to the use and monitoring of aminoglycosides and glycopeptides within the ICUs surveyed. Most of the clinicians stopped antibiotics based on clinical assessment rather than a predetermined duration (eg five days or seven days) and a small number of units used procalcitonin to guide antibiotic therapy.