Low adherence to vancomycin guidelines at an Australian paediatric hospital

Abstract

Background: With increasing bacterial resistance, and the emergence of vancomycin-resistant methicillin-resistant Staphylococcus aureus, it is imperative that vancomycin is used appropriately in hospitals. Aim: To investigate adherence to hospital guidelines for vancomycin dosing and therapeutic drug monitoring. Method: A retrospective audit of vancomycin use was conducted for all inpatients (1 month to 18 years) at a paediatric hospital over an 8 month period. Data from medical records were compared with the hospital guidelines to ascertain adherence to vancomycin dosing and therapeutic drug monitoring. Results: 167 patients received vancomycin and 173 courses of vancomycin prescribed to 124 eligible patients were reviewed. 28% of vancomycin courses adhered to all aspects of the guidelines. Oncology clinicians prescribed 50% of vancomycin courses and adhered to audit criteria in 43% of cases. The most common deviation from the guidelines was under-dosing of vancomycin. Conclusion: Adherence to hospital vancomycin guidelines was poor. Under-dosing was the most significant deviation and is of concern, as subtherapeutic vancomycin dosing has the potential to extend the duration of illness, contribute to adverse health outcomes and increase selection of resistant bacteria.