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Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital

Received: 3 August 2015     Accepted: 8 September 2015     Published: 30 October 2015
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Abstract

Background: Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence vancomycin-resistant enterococci (VRE) which is related to the potential for nosocomial transmission, the lack of antibiotics to treat infections caused by this organism, and the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms such as S. aureus. The objective of this study was to evaluate the utilization of vancomycin among hospitalized patients in internal medicine wards of Tikur Anbessa Specialized Hospital (TASH). Methods: A retrospective cross-sectional chart review was carried out to evaluate the utilization of vancomycin among hospitalized patients with vancomycin therapy between April 2012 to 2013. Results: One hundred twenty five patients were enrolled in the study, consisting of 60 males and 65 females. The age range was 13 to 80 years. Of all courses, 88.8% were considered to be initially appropriate, but this decreased to 6.4% after vancomycin initiation. Continued empiric use of vancomycin without further evidence of gram-positive infections accounted for the majority of inappropriate use. The major dosing regimen employed was 1g every 12 h in 99 (79.2%) of treatments. Vancomycin dose was not adjusted or adjusted inadequately for 62 (96.5%) of the patients with increased serum creatinine. Furosemide was the most frequently identified potentially interactive drug. Conclusion: Although the initial indication for vancomycin use was generally appropriate, failure to continue this antibiotic as per HICPAC criteria and inappropriate dosing adjustment based on MDRD CrCl level were common challenges identified.

Published in American Journal of Health Research (Volume 3, Issue 6)
DOI 10.11648/j.ajhr.20150306.13
Page(s) 333-337
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Vancomycin, Drug Use Evaluation, Hicpac Guideline, Dosage, Interaction

References
[1] Maciej C, Asok K. Vancomycin-resistant Enterococcus. Ann Acad Med Singapore 2008; 37: 861-9.
[2] Moacyr S, Luci C, Alexandre R, et al. Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study. BMC Infectious Diseases 2007; 7(88): 1-6.
[3] Center of Disease Control and Prevention guideline for Antibiotic Resistance Threats in the United States 2013.
[4] Centers of Disease Control and Prevention for management of Multidrug-Resistant Organisms in Healthcare Settings 2007.
[5] Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee (HICPAC). Draft Guidelines for Environmental Infection Control in Healthcare Facilities in Atlanta 2001.
[6] Kevin G, Gerald S, David W, et al. Vancomycin Prescribing Practices in Hospitalized Chronic Hemodialysis Patients. American Journal of Kidney Diseases 2000; 35: 64-68.
[7] Daniela O, Marli S, Renato S. Vancomycin Use in a Hospital with High Prevalence of Methicillin-Resistant Staphylococcus aureus: Comparison with Hospital Infection Control Practices Advisory Committee Guidelines. BJID 2007; 11(1): 53-56.
[8] Drug Administration and Control Authority of Ethiopia in collaboration with Management Sciences for Health, Strengthening Pharmaceutical Systems (MSH/SPS) August 2009.
[9] Wasam L, Mehreen F, Fatima A, Khawaja T. Drug Utilization Evaluation of Vancomycin in Teaching Hospitals of Lahore. J Pharm Sci & Res 2012; 4(2): 1728-33.
[10] Jyothi K, Jagadish Babu D. Drug Utilization Evaluation of Cephalosporins in General Medicine Units of Rural Tertiary Care Hospital. Int J Curr Pharm Res 2012; 4 (2): 88-91.
[11] Navarro, Robert. Drug Utilization Review Strategies. Managed Care Pharmacy Practice 2008; 8: 215-229.
[12] Joyce H, Donald J, Benjamin S, et al. Vancomycin utilization at a teaching hospital in Hong Kong. Am J Health-Syst Pharm 2001; 58: 2167-9.
[13] Afsaneh V, Aziz J, Sakineh S. Vancomycin Utilization Evaluation at Hematology-Oncology Ward of a Teaching Hospital in Iran. Iranian Journal of Pharmaceutical Research 2012; 11 (1): 163-170.
[14] Surendra K, Leanne H, Gillian L, et al. Prevalence and risk factors for VRE colonization in a tertiary hospital in Melbourne, Australia. Antimicrobial Resistance and Infection Control 2012, 1: 31-7.
[15] Alison G, Kent A, Craig A, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases 2011; 52(4): 56-93.
[16] Jagbir G, Rhonda M, Ognjenka D, Adeera L. Use of GFR equations to adjust drug doses in an elderly multi-ethnic group. Nephrol Dial Transplant 2007; 22: 2894-9.
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  • APA Style

    Bereket Zeleke, Ephrem Engidawork. (2015). Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital. American Journal of Health Research, 3(6), 333-337. https://doi.org/10.11648/j.ajhr.20150306.13

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    ACS Style

    Bereket Zeleke; Ephrem Engidawork. Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital. Am. J. Health Res. 2015, 3(6), 333-337. doi: 10.11648/j.ajhr.20150306.13

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    AMA Style

    Bereket Zeleke, Ephrem Engidawork. Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital. Am J Health Res. 2015;3(6):333-337. doi: 10.11648/j.ajhr.20150306.13

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  • @article{10.11648/j.ajhr.20150306.13,
      author = {Bereket Zeleke and Ephrem Engidawork},
      title = {Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital},
      journal = {American Journal of Health Research},
      volume = {3},
      number = {6},
      pages = {333-337},
      doi = {10.11648/j.ajhr.20150306.13},
      url = {https://doi.org/10.11648/j.ajhr.20150306.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20150306.13},
      abstract = {Background: Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence vancomycin-resistant enterococci (VRE) which is related to the potential for nosocomial transmission, the lack of antibiotics to treat infections caused by this organism, and the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms such as S. aureus. The objective of this study was to evaluate the utilization of vancomycin among hospitalized patients in internal medicine wards of Tikur Anbessa Specialized Hospital (TASH). Methods: A retrospective cross-sectional chart review was carried out to evaluate the utilization of vancomycin among hospitalized patients with vancomycin therapy between April 2012 to 2013. Results: One hundred twenty five patients were enrolled in the study, consisting of 60 males and 65 females. The age range was 13 to 80 years. Of all courses, 88.8% were considered to be initially appropriate, but this decreased to 6.4% after vancomycin initiation. Continued empiric use of vancomycin without further evidence of gram-positive infections accounted for the majority of inappropriate use. The major dosing regimen employed was 1g every 12 h in 99 (79.2%) of treatments. Vancomycin dose was not adjusted or adjusted inadequately for 62 (96.5%) of the patients with increased serum creatinine. Furosemide was the most frequently identified potentially interactive drug. Conclusion: Although the initial indication for vancomycin use was generally appropriate, failure to continue this antibiotic as per HICPAC criteria and inappropriate dosing adjustment based on MDRD CrCl level were common challenges identified.},
     year = {2015}
    }
    

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  • TY  - JOUR
    T1  - Drug Utilization Evaluation of Vancomycin Among Hospitalized Patients in Internal Medicine Wards of Tikur Anbessa Specialized Hospital
    AU  - Bereket Zeleke
    AU  - Ephrem Engidawork
    Y1  - 2015/10/30
    PY  - 2015
    N1  - https://doi.org/10.11648/j.ajhr.20150306.13
    DO  - 10.11648/j.ajhr.20150306.13
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 333
    EP  - 337
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20150306.13
    AB  - Background: Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence vancomycin-resistant enterococci (VRE) which is related to the potential for nosocomial transmission, the lack of antibiotics to treat infections caused by this organism, and the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms such as S. aureus. The objective of this study was to evaluate the utilization of vancomycin among hospitalized patients in internal medicine wards of Tikur Anbessa Specialized Hospital (TASH). Methods: A retrospective cross-sectional chart review was carried out to evaluate the utilization of vancomycin among hospitalized patients with vancomycin therapy between April 2012 to 2013. Results: One hundred twenty five patients were enrolled in the study, consisting of 60 males and 65 females. The age range was 13 to 80 years. Of all courses, 88.8% were considered to be initially appropriate, but this decreased to 6.4% after vancomycin initiation. Continued empiric use of vancomycin without further evidence of gram-positive infections accounted for the majority of inappropriate use. The major dosing regimen employed was 1g every 12 h in 99 (79.2%) of treatments. Vancomycin dose was not adjusted or adjusted inadequately for 62 (96.5%) of the patients with increased serum creatinine. Furosemide was the most frequently identified potentially interactive drug. Conclusion: Although the initial indication for vancomycin use was generally appropriate, failure to continue this antibiotic as per HICPAC criteria and inappropriate dosing adjustment based on MDRD CrCl level were common challenges identified.
    VL  - 3
    IS  - 6
    ER  - 

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Author Information
  • College of Medicine and Health Sciences, Madawalabu University, Bale-Goba, Ethiopia

  • Department of pharmacology and clinical pharmacy, Addis Ababa University, Addis Ababa, Ethiopia

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