NDT Advance Access published online on June 19, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn343
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Assessment of vancomycin use in chronic haemodialysis patients: room for improvement
1 Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario, Canada 2 Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada 3 Division of Infectious Disease and Infection Prevention and Control, The Ottawa Hospital, Ottawa, Ontario, Canada
Correspondence and offprint requests to: Rosemary Zvonar, Pharmacy Department, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Tel: +1-613-761-5063; Fax: +1-613-761-4350; E-mail: rzvonar{at}ottawahospital.on.ca
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Abstract |
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Background. Vancomycin is frequently prescribed for the management of infections in haemodialysis patients. We evaluated the appropriateness of vancomycin use in our chronic haemodialysis population.
Methods. Charts of all chronic haemodialysis patients who received vancomycin between 1 March 2003 and 1 March 2004 were retrospectively reviewed. Indication was assessed according to the modified Hospital Infection Control Practices Advisory Committee guidelines for vancomycin prescription. The prescribed dosing regimens were evaluated.
Results. A total of 163 courses of vancomycin in 105 patients were assessed. Of all courses, 88% were considered to be initially appropriate, but this decreased to 63% once culture and sensitivity results were available. Use of vancomycin for the management of beta-lactam-sensitive organisms accounted for the majority of inappropriate use. The most common vancomycin-dosing regimen prescribed was 500 mg intravenously at each haemodialysis session (51%); however, considerable variability was observed.
Conclusions. Although the initial indication for vancomycin use was generally appropriate, inappropriate continuation of this antibiotic, failure to obtain proper cultures to guide therapy and potentially subtherapeutic dosing regimens were some of the challenges identified. Centres providing chronic haemodialysis should take steps to optimize vancomycin prescription to improve clinical outcomes and reduce the risk of antimicrobial resistance.
Keywords: drug use evaluation; haemodialysis; vancomycin
Received for publication: 15. 1.08
Accepted in revised form: 26. 5.08