Analysis of the activities of the clinical pharmacy service in the use of vancomycin in a public hospital in Belo Horizonte

Abstract

Objective: To characterize the population in vancomycin use, and analyze the parameters of indication, effectiveness and safety used by clinical pharmacists in the drug utilization review. Method: This is a cross-sectional study with retrospective collection of medical records of patients who used intravenous vancomycin from March 2022 to March 2023. The results of therapeutic monitoring of vancomycin and pharmaceutical interventions related to this antibacterial were evaluated. Results: The study included 919 patients with 1026 hospital admissions. The mean age of the population was 56.8±17.9 years and 50.9% were older than 60 years. In the period evaluated, 9379 vancomycin prescriptions were identified. The most prevalent reason for vancomycin prescription was “others: cite in observation” (15.1%), followed by “respiratory infection - nosocomial pneumonia” (14.8%). The care line responsible for most of the vancomycin prescriptions (42.9%) were the intensive care. Only 23.5% of the serum vancomycin trough concentrations results were in the range considered ideal, i.e. 15-20mg/L. Among the results that were outside the reference range, 38.2% were supratherapeutic (≥20.1mg/L) and 18.7% were subtherapeutic (≤9.9mg/L). In the drug utilization review led by pharmacists, 190 interventions were performed with the medical team. The therapeutic monitoring of vancomycin was the most prevalent intervention (44.7%) of which 87.1% were accepted. Conclusion: The study showed a high rate of serum vancomycin trough concentrations results outside the therapeutic range (76.5%) indicating the need to strengthen the institutional protocol and clinical staff training. The clinical pharmacist had an important role in identifying this risk by performing drug utilization review and therapeutic monitoring of vancomycin.