Validation of a new vancomycin dosing nomogram within a pharmacist- led therapeutic drug monitoring program
Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Introduction: Vancomycin is a glycopeptide antibiotic used to treat different kinds of severe Gram positive infections. Alfred Health is the leading hospital in Australia in using vancomycin. Today, there are many guidelines for initiation of vancomycin but little evidence on maintenance dosing. Alfred Health has introduced a nomogram as a guideline for maintenance dosing. Aim: To measure the extent to which the clinical pharmacists have followed the nomogram to achieve the target trough range (15-20 mg/L) in vancomycin maintenance dosing at Alfred Health. Materials and Methods: Vancomycin levels from 161 patients in Alfred Health were collected. Patients’ clinical characteristics were recorded, as well as initiation and maintenance dosing of vancomycin using a Data Collection Tool. The data was then analyzed in Microsoft Excel 2003. Results: Of the 161 collected patients, 130 were included with a total of 491 levels taken. Of these levels, 32.8% were therapeutic, 57.6% were above minimum target and 15.2% were supratherapeutic. Twenty-nine patients (5.9%) had a new incidence of acute renal failure. There were a total of 113 patients that reached steady state with a total of 312 levels taken. Out of these levels, 86.5% were adjusted according to the nomogram. Conclusions: The majority of steady state levels were adjusted according to the nomogram. Opportunity exists to use this only as a pilot study and later repeat in larger population. It has been shown in the study that various dosage adjustment practices exist. Further work to improve today’s practice is required.
Place, publisher, year, edition, pages
2014. , 39 p.
therapeutic drug monitoring, vancomycin, validation, nomogram
Social and Clinical Pharmacy
IdentifiersURN: urn:nbn:se:uu:diva-216415OAI: oai:DiVA.org:uu-216415DiVA: diva2:689748
Department of Pharmacy, Alfred Hospital, Melbourne, Australia
Subject / course
Master of Science Programme in Pharmacy