Abstract
The purpose of this study was to investigate the situation of intravenous vancomycin (VCM) prescribing as well as the effect of implementing recommendations in this regard at Kobe City General Hospital where no such investigation had been done before.
All intravenous VCM prescriptions were monitored prospectively over a 6 month-period in 2001 and then based on an analysis of the first 100 cases, the hospital infection control committee and hospital pharmacy drafted recommendations for the proper use of VCM. After they were implemented hospital-wide, VCM prescribing was prospectively monitored for another 100 cases in 2002 and the impact of the recommendations was evaluated.
Pneumonia and wound infections were the major indications for VCM both before and after the recommendations. The duration of intravenous VCM use (19.5 days vs.13.1 days ; p<0.01) and hospitalization (100.1 days vs.83.1 days ; p<0.05) were significantly shorter after the recommendations. Frequency of death and clinical success, defined as improvement in symptoms or cure, remained the same, however. Frequency of therapeutic drug monitoring increased significantly after the recommendations (56 vs.71 ; p<0.05) and the incidence of adverse reactions such as flushing decreased accordingly (12 vs. 1 ; p<0.01).
Implementation of the recommendations was effective in promoting the proper use of VCM and reducing the duration of VCM therapy, length of hospital stays, and overall cost of patient care.
