Common Errors Related to Vancomycin Pharmacokinetics, Prescribed by Physicians in Iran: Suggesting Practical Approaches for Adjusting the Right Dose
Abstract
Background: Vancomycin is a glycopeptide antibiotic that is widely used for the treatment of gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus. It is a valuable antibiotic in practice; unfortunately, its excessive use and mistakes in prescription have increased bacterial resistance. Hence, this study seeks to investigate the common errors related to the pharmacokinetics of vancomycin prescription in teaching hospitals in Iran.Methods: This study is an observational study that research orders with errors related to pharmacokinetics parameters of vancomycin. A total of 150 patients were enrolled in the study from May 2016 to September 2018 in teaching hospitals. Errors in drug prescription were identified based on literature resources.Results: About 22.7% of patients did not receive the loading dose. Also, 85.3% of patients were prescribed a fixed dose, instead of weight-based dosing. About 46% of patients had kidney problems (chronic kidney disease or acute kidney injury) and all of them had received a much lower dose than they needed according to guidelines. Another 46% of patients did not undergo therapeutic dose monitoring correctly. Finally, 69.3% of patients had not received consequent doses after encountering a nontherapeutic trough level correctly. Also, none of 22 obese patients with a body mass index of greater than 40 kg/m2, had received the proper dose.Conclusion: Since the incorrect use of vancomycin significantly increases the prevalence of resistant organisms and, consequently, the mortality rate of patients, it is necessary to define guidelines for its use in the hospital.
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4. Kuo GM, Touchette DR, Marinac JS. Drug errors and related interventions reported by United States clinical pharmacists: The American college of clinical pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacotherapy. 2013; 33(3):253-65. [DOI:10.1002/phar.1195] [PMID]
5. Ayubi MS, Elyasi S, Jannati M, Vahdati-Mashhadian N, Saberi MR, Naderi HR, et al. Vancomycin utilization evaluation in a tertiary teaching hospital in Mashhad, Iran. J Pharm Care. 2018; 5(3-4):44-48.
6. Murphy JE. Basic & Applied Pharmacokinetics Self Assessment. 2014: ASHP. Maryland: Bethesda; 2014.
7. Brown DL, Mauro LS. Vancomycin dosing chart for use in patients with renal impairment. Am J Kidney Dis. 1988; 11(1):15-9. [DOI:10.1016/ S0272-6386(88)80168-9] [PMID]
8. Stanford Hospital & Clinics, Stanford University Medical center. Adult Vancomycin Loading Dose Guidelines for the ED [Internet]. 2013 [Updated 2013 May] Available from: http://med.stanford.edu/content/ dam/sm/bugsanddrugs/documents/dosing/2013VancEDloadingdo se_000.pdf
9. Šíma M, Hartinger J, Cikánková T, Slanař O. Importance of vancomycin loading doses in intermittent infusion regimens. J Infect Chemother. 2018; 24(4):247-50. [DOI:10.1016/j.jiac.2017.11.002] [PMID]
10. Álvarez O, Plaza-Plaza JC, Ramirez M, Peralta A, Amador CA, Amador R. Pharmacokinetic assessment of vancomycin loading dose in critically ill patients. Antimicrob Agents Chemother. 2017; 61(8)e00280-17. [DOI:10.1128/AAC.00280-17] [PMID] [PMCID]
11. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al., Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011; 52(3): e18-55. [DOI:10.1093/cid/ciq146] [PMID]
12. Sivagnanam S, Deleu D. Red man syndrome. Crit Care. 2003; 7(2):11920. [DOI:10.1186/cc1871] [PMID] [PMCID]
13. Rybak M, Lomaestro B, Rotschafer JC, Moellering R Jr, Craig W, Billeter M, 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. Am J Health Syst Pharm. 2009; 66(1):82-98. [DOI:10.2146/ajhp080434] [PMID]
14. Weinstein MP, Patel JB, Bobenchik AM, Campeau S, Cullen SK, Galas MF, et al. Performance standards for antimicrobial susceptibility testing. Pennsylvania: Clinical and Laboratory Standards Institute; 2016.
15. Kishk OA, Lardieri AB, Heil EL, Morgan JA. Vancomycin AUC/MIC and corresponding troughs in a pediatric population. J Pediatr Pharmacol Ther. 2017; 22(1):41-7. [DOI:10.5863/1551-6776-22.1.41] [PMID] [PMCID]
16. Moise PA, Forrest A, Bhavnani SM, Birmingham MC, Schentag JJ. Area under the inhibitory curve and a pneumonia scoring system for predicting outcomes of vancomycin therapy for respiratory infections by Staphylococcus aureus. Am J Health Syst Pharm. 2000; 57(Suppl. 2):S4-9. [DOI:10.1093/ajhp/57.suppl_2.S4] [PMID]
17. Rodriguez CA, Agudelo M, Zuluaga AF, Vesga O. Generic vancomycin enriches resistant subpopulations of Staphylococcus aureus after exposure in a neutropenic mouse thigh infection model. Antimicrob Agents Chemother. 2012; 56(1):243-7. [DOI:10.1128/AAC.05129-11] [PMID] [PMCID]
18. Moise-Broder PA, Forrest A, Birmingham MC, Schentag JJ. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections. Clinical pharmacokinet. 2004: 43(13):925-42. [DOI:10.2165/00003088-20044313000005] [PMID]
19. Matzke GR, McGory RW, Halstenson CE, Keane WF. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrobial Agents and Chemother. 1984; 25(4):433-7. [DOI:10.1128/ AAC.25.4.433] [PMID] [PMCID]
20. Howden BP, Ward PB, Charles PG, Korman TM, Fuller A, du Cros P, et al. Treatment outcomes for serious infections caused by methicillin-resistant staphylococcus aureus with reduced vancomycin susceptibility. Clin Infect Dis. 2004; 38(4):521-8. [DOI:10.1086/381202] [PMID]
21. Charles PG, Ward PB, Johnson PD, Howden BP, Grayson ML. Clinical features associated with bacteremia due to heterogeneous vancomycin-intermediate Staphylococcus aureus. Clin Infect Dis. 2004; 38(3):448-51. [DOI:10.1086/381093] [PMID]
22. Bel Kamel A, Bourguignon L, Marcos M, Ducher M, Goutelle S. Is Trough concentration of vancomycin predictive of the area under the curve? a clinical study in elderly patients. Ther Drug Monit. 2017; 39(1):83-7. [DOI:10.1097/FTD.0000000000000359] [PMID]
23. Neely MN, Youn G, Jones B, Jelliffe RW, Drusano GL, Rodvold KA, et al. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob Agents Chemother. 2014; 58(1):309-16. [DOI:10.1128/AAC.01653-13] [PMID] [PMCID]
24. Ibrahim N, Manan MM. AUC/MIC ratio as a tool in determining effectiveness of garasent® for the prevention of early onset sepsis in hospitalized neonates. Int J Pharm Pharm Sci. 2014; 6(Suppl 3):24-8.
25. Mohr JF, Murray BE. Point: Vancomycin is not obsolete for the treatment of infection caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2007; 44(12):1536-42. [DOI:10.1086/518451] [PMID]
26. Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006; 42(Supplement_1):S35-9. [DOI:10.1086/491712] [PMID]
27. Craig WA. Basic pharmacodynamics of antibacterials with clinical applications to the use of β-lactams, glycopeptides, and linezolid. Infect Dis Clin North Am. 2003; 17(3):479-501. [DOI:10.1016/ S0891-5520(03)00065-5] [PMID]
28. Shahrami B, Najmeddin F, Mousavi S, Ahmadi A, Rouini MR, Sadeghi K. Achievement of vancomycin therapeutic goals in critically ill patients: Early individualization may be beneficial. Crit Care Res Pract. 2016; 2016:1245815. [DOI:10.1155/2016/1245815] [PMID] [PMCID]
29. Crew P, Heintz SJ, Heintz BH. Heintz, vancomycin dosing and monitoring for patients with end-stage renal disease receiving intermittent hemodialysis. Am J Health Syst Pharm. 2015; 72(21):1856-64. [DOI:10.2146/ajhp150051] [PMID]
30. Taylor ME, Allon M. Practical vancomycin dosing in hemodialysis patients in the era of emerging vancomycin resistance: A single-center experience. Am J Kidney Dis. 2010; 55(6):1163-5. [DOI:10.1053/j.ajkd.2010.03.016] [PMID] [PMCID]
31. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005; 41(8):1159-66. [DOI:10.1086/444500] [PMID]
32. Blot S, Lipman J, Roberts DM, Roberts JA. The influence of acute kidney injury on antimicrobial dosing in critically ill patients: Are dose reductions always necessary? Diagn Microbiol Infect Dis. 2014; 79(1):77-84. [DOI:10.1016/j.diagmicrobio.2014.01.015] [PMID]
33. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012. 2(1):1-138.
34. Kullar R, Davis SL, Levine DP, Rybak MJ. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: Support for consensus guidelines suggested targets. Clin Infect Dis. 2011; 52(8):975-81. [DOI:10.1093/ cid/cir124] [PMID]
35. Reseau De Sante Horizon Health Network, Reseau De Sante Vitalite Health Network. Vancomycin dosing & monitoring guideline [Internet] 2018 [Updated 2018 Sep]. Available from: https:// en.horizonnb.ca/media/927891/vancomycin_dosing_and_monitoring_guidelines.pdf
36. Herman RA. Cases: Gentamicin &vancomycin pharmacokinetics [Internet]. 2016 [Updated 2016 Feb 29]. Available from: https:// rherman.pharmacy.uiowa.edu/CPK/AbxCasesHandout.pdf
37. Ziadi STR, Roberts JA. Drug dosing in obesity. Sydney: Springer; 2016.
2. Moellering RC Jr. Vancomycin: A 50-year reassessment. Clin Infect Dis. 2006; (42 Suppl 1):S3-4. [DOI:10.1086/491708] [PMID]
3. Bonten MJ, Willems R, Weinstein RA. Vancomycin-resistant enterococci: why are they here, and where do they come from? Lancet Infect Dis. 2001; 1(5):314-25. [DOI:10.1016/S1473-3099(01)001451] [PMID]
4. Kuo GM, Touchette DR, Marinac JS. Drug errors and related interventions reported by United States clinical pharmacists: The American college of clinical pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacotherapy. 2013; 33(3):253-65. [DOI:10.1002/phar.1195] [PMID]
5. Ayubi MS, Elyasi S, Jannati M, Vahdati-Mashhadian N, Saberi MR, Naderi HR, et al. Vancomycin utilization evaluation in a tertiary teaching hospital in Mashhad, Iran. J Pharm Care. 2018; 5(3-4):44-48.
6. Murphy JE. Basic & Applied Pharmacokinetics Self Assessment. 2014: ASHP. Maryland: Bethesda; 2014.
7. Brown DL, Mauro LS. Vancomycin dosing chart for use in patients with renal impairment. Am J Kidney Dis. 1988; 11(1):15-9. [DOI:10.1016/ S0272-6386(88)80168-9] [PMID]
8. Stanford Hospital & Clinics, Stanford University Medical center. Adult Vancomycin Loading Dose Guidelines for the ED [Internet]. 2013 [Updated 2013 May] Available from: http://med.stanford.edu/content/ dam/sm/bugsanddrugs/documents/dosing/2013VancEDloadingdo se_000.pdf
9. Šíma M, Hartinger J, Cikánková T, Slanař O. Importance of vancomycin loading doses in intermittent infusion regimens. J Infect Chemother. 2018; 24(4):247-50. [DOI:10.1016/j.jiac.2017.11.002] [PMID]
10. Álvarez O, Plaza-Plaza JC, Ramirez M, Peralta A, Amador CA, Amador R. Pharmacokinetic assessment of vancomycin loading dose in critically ill patients. Antimicrob Agents Chemother. 2017; 61(8)e00280-17. [DOI:10.1128/AAC.00280-17] [PMID] [PMCID]
11. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al., Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011; 52(3): e18-55. [DOI:10.1093/cid/ciq146] [PMID]
12. Sivagnanam S, Deleu D. Red man syndrome. Crit Care. 2003; 7(2):11920. [DOI:10.1186/cc1871] [PMID] [PMCID]
13. Rybak M, Lomaestro B, Rotschafer JC, Moellering R Jr, Craig W, Billeter M, 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. Am J Health Syst Pharm. 2009; 66(1):82-98. [DOI:10.2146/ajhp080434] [PMID]
14. Weinstein MP, Patel JB, Bobenchik AM, Campeau S, Cullen SK, Galas MF, et al. Performance standards for antimicrobial susceptibility testing. Pennsylvania: Clinical and Laboratory Standards Institute; 2016.
15. Kishk OA, Lardieri AB, Heil EL, Morgan JA. Vancomycin AUC/MIC and corresponding troughs in a pediatric population. J Pediatr Pharmacol Ther. 2017; 22(1):41-7. [DOI:10.5863/1551-6776-22.1.41] [PMID] [PMCID]
16. Moise PA, Forrest A, Bhavnani SM, Birmingham MC, Schentag JJ. Area under the inhibitory curve and a pneumonia scoring system for predicting outcomes of vancomycin therapy for respiratory infections by Staphylococcus aureus. Am J Health Syst Pharm. 2000; 57(Suppl. 2):S4-9. [DOI:10.1093/ajhp/57.suppl_2.S4] [PMID]
17. Rodriguez CA, Agudelo M, Zuluaga AF, Vesga O. Generic vancomycin enriches resistant subpopulations of Staphylococcus aureus after exposure in a neutropenic mouse thigh infection model. Antimicrob Agents Chemother. 2012; 56(1):243-7. [DOI:10.1128/AAC.05129-11] [PMID] [PMCID]
18. Moise-Broder PA, Forrest A, Birmingham MC, Schentag JJ. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections. Clinical pharmacokinet. 2004: 43(13):925-42. [DOI:10.2165/00003088-20044313000005] [PMID]
19. Matzke GR, McGory RW, Halstenson CE, Keane WF. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrobial Agents and Chemother. 1984; 25(4):433-7. [DOI:10.1128/ AAC.25.4.433] [PMID] [PMCID]
20. Howden BP, Ward PB, Charles PG, Korman TM, Fuller A, du Cros P, et al. Treatment outcomes for serious infections caused by methicillin-resistant staphylococcus aureus with reduced vancomycin susceptibility. Clin Infect Dis. 2004; 38(4):521-8. [DOI:10.1086/381202] [PMID]
21. Charles PG, Ward PB, Johnson PD, Howden BP, Grayson ML. Clinical features associated with bacteremia due to heterogeneous vancomycin-intermediate Staphylococcus aureus. Clin Infect Dis. 2004; 38(3):448-51. [DOI:10.1086/381093] [PMID]
22. Bel Kamel A, Bourguignon L, Marcos M, Ducher M, Goutelle S. Is Trough concentration of vancomycin predictive of the area under the curve? a clinical study in elderly patients. Ther Drug Monit. 2017; 39(1):83-7. [DOI:10.1097/FTD.0000000000000359] [PMID]
23. Neely MN, Youn G, Jones B, Jelliffe RW, Drusano GL, Rodvold KA, et al. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob Agents Chemother. 2014; 58(1):309-16. [DOI:10.1128/AAC.01653-13] [PMID] [PMCID]
24. Ibrahim N, Manan MM. AUC/MIC ratio as a tool in determining effectiveness of garasent® for the prevention of early onset sepsis in hospitalized neonates. Int J Pharm Pharm Sci. 2014; 6(Suppl 3):24-8.
25. Mohr JF, Murray BE. Point: Vancomycin is not obsolete for the treatment of infection caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2007; 44(12):1536-42. [DOI:10.1086/518451] [PMID]
26. Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006; 42(Supplement_1):S35-9. [DOI:10.1086/491712] [PMID]
27. Craig WA. Basic pharmacodynamics of antibacterials with clinical applications to the use of β-lactams, glycopeptides, and linezolid. Infect Dis Clin North Am. 2003; 17(3):479-501. [DOI:10.1016/ S0891-5520(03)00065-5] [PMID]
28. Shahrami B, Najmeddin F, Mousavi S, Ahmadi A, Rouini MR, Sadeghi K. Achievement of vancomycin therapeutic goals in critically ill patients: Early individualization may be beneficial. Crit Care Res Pract. 2016; 2016:1245815. [DOI:10.1155/2016/1245815] [PMID] [PMCID]
29. Crew P, Heintz SJ, Heintz BH. Heintz, vancomycin dosing and monitoring for patients with end-stage renal disease receiving intermittent hemodialysis. Am J Health Syst Pharm. 2015; 72(21):1856-64. [DOI:10.2146/ajhp150051] [PMID]
30. Taylor ME, Allon M. Practical vancomycin dosing in hemodialysis patients in the era of emerging vancomycin resistance: A single-center experience. Am J Kidney Dis. 2010; 55(6):1163-5. [DOI:10.1053/j.ajkd.2010.03.016] [PMID] [PMCID]
31. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005; 41(8):1159-66. [DOI:10.1086/444500] [PMID]
32. Blot S, Lipman J, Roberts DM, Roberts JA. The influence of acute kidney injury on antimicrobial dosing in critically ill patients: Are dose reductions always necessary? Diagn Microbiol Infect Dis. 2014; 79(1):77-84. [DOI:10.1016/j.diagmicrobio.2014.01.015] [PMID]
33. Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012. 2(1):1-138.
34. Kullar R, Davis SL, Levine DP, Rybak MJ. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: Support for consensus guidelines suggested targets. Clin Infect Dis. 2011; 52(8):975-81. [DOI:10.1093/ cid/cir124] [PMID]
35. Reseau De Sante Horizon Health Network, Reseau De Sante Vitalite Health Network. Vancomycin dosing & monitoring guideline [Internet] 2018 [Updated 2018 Sep]. Available from: https:// en.horizonnb.ca/media/927891/vancomycin_dosing_and_monitoring_guidelines.pdf
36. Herman RA. Cases: Gentamicin &vancomycin pharmacokinetics [Internet]. 2016 [Updated 2016 Feb 29]. Available from: https:// rherman.pharmacy.uiowa.edu/CPK/AbxCasesHandout.pdf
37. Ziadi STR, Roberts JA. Drug dosing in obesity. Sydney: Springer; 2016.
| Files | ||
| Issue | Vol 4 No 1/2 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Inappropriate prescribing Iran Pharmacokinetics Vancomycin | ||
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How to Cite
1.
Barati S, Sahraei Z. Common Errors Related to Vancomycin Pharmacokinetics, Prescribed by Physicians in Iran: Suggesting Practical Approaches for Adjusting the Right Dose. JPPM. 2018;4(1/2):1-9.
