Impact of the pharmacist's request for vancomycin dosage in a university hospital: observational study

Authors

DOI:

https://doi.org/10.30968/rbfhss.2023.141.0819

Abstract

Objective: Considering the Resolution of the Collegiate Board RDC 586 of 2013, which regulates the clinical actions of the pharmacist, among them the prescription of laboratory tests to monitor the pharmacotherapy, the study aims to evaluate the impact of the request for vancomycin serum concentration by the pharmacist in a university hospital compared to other professionals. Methods: Patients who used vancomycin within a four-month period were included, being divided into group A, with patients who underwent the examination having the exclusive prescription by the assistant medical team between July and August 2021, and in group B with the examination prescribed by the pharmacist, between September and October 2021, patient demographic data, laboratory results of creatinine and dosage of vancomycin, number of vancomycin dosages collected, etiology of infections, culture results, and de-escalation of therapy were collected. Results: 22 patients were included for group A and 23 for group B. The results of initial and final creatinine, creatinine change, nephrotoxicity and vancomycin trough result in the therapeutic target did not show statistical differences between the groups. The total number of collections and the number of collections until reaching the therapeutic target of each patient differed between the groups, being higher in both for group B (p=0.01), requested by the pharmacist. In addition, the number of patients who reached the therapeutic target was 16 (69.56%) for group B against 6 (27.27%) for group A (p=0.01). Conclusion: The findings suggested pharmaceutical action in the follow-up of vancokinemia, as well as the direct prescription of the plasma dosage test of this antimicrobial by this professional, can contribute to greater therapeutic success and obtaining the optimized dosage for the individuality of each patient.

Downloads

Download data is not yet available.

References

James MR, Flower R,Henderson F et al. Rang & Dale: farmacologia. 9. ed. Rio de Janeiro: GEN Guanabara Koogan; 2020.

Levine DP. Vancomycin: A History. Clin Infec Dis. 2006;42:S5–S12. DOI: 10.1086/491709.

Rybak M, Lomaestro B, Rotschafer JC et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Ame Jour of Heal-Syst Pharm. 2009;66:82–98. DOI: 10.2146/ajhp080434.

Rybak MJ, Le J, Lodise TP et al. Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Clin Infec Dis. 2020;71:1361–1364. DOI: 10.1093/cid/ciaa303.

Conselho Federal de Farmácia. Resolução - RDC no 586, de 29 de agosto de 2013. Brasil: Regulamenta as atribuições clínicas do farmacêutico e dá outras providências; 2013; 1–11.

Drew RH, Sakoulas G. Vancomycin: Parenteral dosing, monitoring, and adverse effects in adults - UpToDate. 2017. Available in: https://www.uptodate.com/contents/vancomycin-parenteral-dosing-monitoring-and-adverse-effects-in-adults. Accessed on: 5st Jan 2022.

ANVISA. Diretriz Nacional para Elaboração de Programa de Gerenciamento do Uso de Antimicrobianos em Serviços de Saúde. 2017.

van Hal SJ, Paterson DL, Lodise TP. Systematic Review and Meta-Analysis of Vancomycin-Induced Nephrotoxicity Associated with Dosing Schedules That Maintain Troughs between 15 and 20 Milligrams per Liter. Ant Agen and Chem. 2013;57:734–744. DOI: 10.1128/AAC.01568-12.

Momattin H, Zogheib M, Homoud A et al. Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring. Chemotherapy. 2016;61:3–7. DOI: 10.1159/000440607.

Masuda N, Maiguma T, Komoto A et al. Impact of pharmacist intervention in preventing nephrotoxicity from vancomycin. Inter Jour of Clin Pharm and Therap. 2015;53:284–291. DOI: 10.5414/CP202274.

Smith AP, Millares-Sipin CA, James M et al. Impact of a Pharmacist-Initiated Vancomycin Monitoring Program. The Cons Pharm. 2016;31:505–510. DOI: 10.4140/TCP.n.2016.505.

Marquis KA, DeGrado JR, Labonville S et al. Evaluation of a Pharmacist-Directed Vancomycin Dosing and Monitoring Pilot Program at a Tertiary Academic Medical Center. Annals of Pharm. 2015;49:1009–1014. DOI: 10.1177/1060028015587900.

Published

2023-03-31

How to Cite

1.
ESPRENDOR RF, SILVA GT, BANHUK FW, CALDEIRA LF, SANCHES AC. Impact of the pharmacist’s request for vancomycin dosage in a university hospital: observational study. Rev Bras Farm Hosp Serv Saude [Internet]. 2023Mar.31 [cited 2024Nov.16];14(1):819. Available from: https://rbfhss.org.br/sbrafh/article/view/819

Issue

Section

ORIGINAL ARTICLES

Most read articles by the same author(s)