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

摘要

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.