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Vancomycin dosing and therapeutic drug monitoring practices : guidelines versus real-life

Tatjana Van Der Heggen (UGent) , Franky Buyle (UGent) , Barbara Claus (UGent) , Annemie Somers (UGent) , Petra Schelstraete (UGent) , Peter De Paepe (UGent) , Sophie Vanhaesebrouck (UGent) and Pieter De Cock (UGent)
Author
Organization
Abstract
Background Correct dosing and therapeutic drug monitoring (TDM) practices are essential when aiming for optimal vancomycin treatment. Objective To assess target attainment after initial dosing and dose adjustments, and to determine compliance to dosing and TDM guidelines. Setting Tertiary care university hospital in Belgium. Method A chart review was performed in 150 patients, ranging from preterm infants to adults, treated intravenously with vancomycin. Patient characteristics, dosing and TDM data were compared to evidence-based hospital guidelines. Main outcome measures Target attainment of vancomycin after initial dosing and dose adjustments. Results Subtherapeutic concentrations were measured in 68% of adults, in 76% of children and in 52% of neonates after treatment initiation. Multiple dose adaptations (median 2, Q1 1-Q3 2) were required for target attainment, whilst more than 20% of children and neonates never reached targeted concentrations. Regarding compliance to the hospital guideline, some points of improvement were identified: omitted dose adjustment in adults with decreased renal function (53%), delayed sampling (16% in adults, 31% in children) and redundant sampling (34% of all samples in adults, 12% in children, 13% in neonates). Conclusion Target attainment for vancomycin with current dosing regimens and TDM is poor in all age groups. Besides, human factors should not be ignored when aiming for optimal treatment. This study reflects an ongoing challenge in clinical practice and highlights the need for optimization of vancomycin dosing strategies and improvement of awareness of all health care professionals involved.
Keywords
Toxicology, Pharmacology (medical), Pharmacology, Pharmaceutical Science, Pharmacy, Antibiotic dosing, Belgium, Dosing errors, Therapeutic drug monitoring, Vancomycin, SERUM TROUGH CONCENTRATIONS, CRITICALLY-ILL PATIENTS, UNIT, PHARMACOKINETICS, POPULATION, INFECTIONS, STRATEGIES, INFUSION, REGIMENS, INFANTS

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MLA
Van Der Heggen, Tatjana, et al. “Vancomycin Dosing and Therapeutic Drug Monitoring Practices : Guidelines versus Real-Life.” INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2021, doi:10.1007/s11096-021-01266-7.
APA
Van Der Heggen, T., Buyle, F., Claus, B., Somers, A., Schelstraete, P., De Paepe, P., … De Cock, P. (2021). Vancomycin dosing and therapeutic drug monitoring practices : guidelines versus real-life. INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. https://doi.org/10.1007/s11096-021-01266-7
Chicago author-date
Van Der Heggen, Tatjana, Franky Buyle, Barbara Claus, Annemie Somers, Petra Schelstraete, Peter De Paepe, Sophie Vanhaesebrouck, and Pieter De Cock. 2021. “Vancomycin Dosing and Therapeutic Drug Monitoring Practices : Guidelines versus Real-Life.” INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. https://doi.org/10.1007/s11096-021-01266-7.
Chicago author-date (all authors)
Van Der Heggen, Tatjana, Franky Buyle, Barbara Claus, Annemie Somers, Petra Schelstraete, Peter De Paepe, Sophie Vanhaesebrouck, and Pieter De Cock. 2021. “Vancomycin Dosing and Therapeutic Drug Monitoring Practices : Guidelines versus Real-Life.” INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. doi:10.1007/s11096-021-01266-7.
Vancouver
1.
Van Der Heggen T, Buyle F, Claus B, Somers A, Schelstraete P, De Paepe P, et al. Vancomycin dosing and therapeutic drug monitoring practices : guidelines versus real-life. INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. 2021;
IEEE
[1]
T. Van Der Heggen et al., “Vancomycin dosing and therapeutic drug monitoring practices : guidelines versus real-life,” INTERNATIONAL JOURNAL OF CLINICAL PHARMACY, 2021.
@article{8708211,
  abstract     = {{Background Correct dosing and therapeutic drug monitoring (TDM) practices are essential when aiming for optimal vancomycin treatment. Objective To assess target attainment after initial dosing and dose adjustments, and to determine compliance to dosing and TDM guidelines. Setting Tertiary care university hospital in Belgium. Method A chart review was performed in 150 patients, ranging from preterm infants to adults, treated intravenously with vancomycin. Patient characteristics, dosing and TDM data were compared to evidence-based hospital guidelines. Main outcome measures Target attainment of vancomycin after initial dosing and dose adjustments. Results Subtherapeutic concentrations were measured in 68% of adults, in 76% of children and in 52% of neonates after treatment initiation. Multiple dose adaptations (median 2, Q1 1-Q3 2) were required for target attainment, whilst more than 20% of children and neonates never reached targeted concentrations. Regarding compliance to the hospital guideline, some points of improvement were identified: omitted dose adjustment in adults with decreased renal function (53%), delayed sampling (16% in adults, 31% in children) and redundant sampling (34% of all samples in adults, 12% in children, 13% in neonates). Conclusion Target attainment for vancomycin with current dosing regimens and TDM is poor in all age groups. Besides, human factors should not be ignored when aiming for optimal treatment. This study reflects an ongoing challenge in clinical practice and highlights the need for optimization of vancomycin dosing strategies and improvement of awareness of all health care professionals involved.}},
  author       = {{Van Der Heggen, Tatjana and Buyle, Franky and Claus, Barbara and Somers, Annemie and Schelstraete, Petra and De Paepe, Peter and Vanhaesebrouck, Sophie and De Cock, Pieter}},
  issn         = {{2210-7703}},
  journal      = {{INTERNATIONAL JOURNAL OF CLINICAL PHARMACY}},
  keywords     = {{Toxicology,Pharmacology (medical),Pharmacology,Pharmaceutical Science,Pharmacy,Antibiotic dosing,Belgium,Dosing errors,Therapeutic drug monitoring,Vancomycin,SERUM TROUGH CONCENTRATIONS,CRITICALLY-ILL PATIENTS,UNIT,PHARMACOKINETICS,POPULATION,INFECTIONS,STRATEGIES,INFUSION,REGIMENS,INFANTS}},
  language     = {{eng}},
  title        = {{Vancomycin dosing and therapeutic drug monitoring practices : guidelines versus real-life}},
  url          = {{http://dx.doi.org/10.1007/s11096-021-01266-7}},
  year         = {{2021}},
}

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