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. 2020 May;86(5):958-965.
doi: 10.1111/bcp.14205. Epub 2020 Jan 22.

Vancomycin: Audit of American guideline-based intermittent dose administration with focus on overweight patients

Mari Koyanagi  1 , Rebecca Anning  1 , Mark Loewenthal  1   2 , Jennifer H Martin  1   2
Affiliations

Vancomycin: Audit of American guideline-based intermittent dose administration with focus on overweight patients

Mari Koyanagi et al. Br J Clin Pharmacol. 2020 May.

Abstract

Aims: Vancomycin dosing and monitoring recommendations are poorly adhered to in many institutions internationally, with concerns of treatment failure and propelling antibiotic resistance. The primary aim of this study was to audit the rate of adherence to American guidelines, with particular interest in loading dose administration. The secondary aims were (i) to determine whether or not guideline adherence results in therapeutic concentrations across body mass index (BMI) groups and (ii) to determine whether or not this was in turn associated with morbidity and hospital mortality.

Method: Data were collected in a single tertiary hospital on all patients who had two or more serum vancomycin concentrations measured.

Result: In total, 107 patients met the inclusion criteria. Overall, 38.3% of patients were commenced on guideline adherent vancomycin doses, and 28.3% of overweight patients received an adherent first dose compared to 51.1% of non-overweight people (difference 23%, 95% CI 4% to 41%, P = 0.024). Overweight patients were more frequently underdosed compared to non-overweight patients (P = 0.039). The frequency and proportion of underdosing increased with BMI. Overweight patients spent a smaller fraction of their course within the therapeutic range, although the difference was not statistically significant (difference 7.7%; 95% CI 4% to 19.4%; P = 0.195). The overweight group had longer hospital length of stay (LOS), higher mortality and more treatment failures.

Conclusion: Adherence to guideline-based prescription is poor, particularly in overweight patients. Patients who are initially underdosed have fewer therapeutic vancomycin days, regardless of BMI. Overweight patients have increased hospital LOS, hospital mortality and treatment failure.

Keywords: guideline-based dosing; obesity; trough concentration; vancomycin.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Figure 1
Figure 1
Graphical representation of the number of patients who received vancomycin therapy and their dose adherence
Figure 2
Figure 2
Kaplan‐Meier curve representing the proportion of patients in each group who did not reach therapeutic concentrations
See this image and copyright information in PMC

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