A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town
Background: Antimicrobial stewardship principles guide the clinical use of antimicrobials, including vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa. Objectives: To document the use, prescribing practices and monitoring of intravenous vancomycin a...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2023-11-01
|
| Series: | Southern African Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | https://sajid.co.za/index.php/sajid/article/view/528 |
| _version_ | 1797405080487460864 |
|---|---|
| author | Leonore Greybe Brian S. Eley Hafsah D. Tootla Anna M.M. Botha Wisdom Basera James J.C. Nuttall |
| author_facet | Leonore Greybe Brian S. Eley Hafsah D. Tootla Anna M.M. Botha Wisdom Basera James J.C. Nuttall |
| author_sort | Leonore Greybe |
| collection | DOAJ |
| description | Background: Antimicrobial stewardship principles guide the clinical use of antimicrobials, including vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa.
Objectives: To document the use, prescribing practices and monitoring of intravenous vancomycin and the spectrum of bacteria isolated on microbiological culture in children treated with intravenous vancomycin during a 12-month period at Red Cross War Memorial Children’s Hospital (RCWMCH).
Method: A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019 was performed.
Results: All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy per 1000 patient days (interquartile range [IQR]: 38–72). The median starting dose was 15 mg/kg per dose (IQR: 14–15) and median daily dose was 45 mg/kg per day (IQR: 43–60). Vancomycin was prescribed as empiric (127/158, 80%) and directed (31/158, 20%) treatment. The median duration of treatment for the directed group (7 days) was longer than the empiric group (4 days) (p = 0.001). Vancomycin serum trough concentrations were performed in 65/98 (66%) episodes where vancomycin treatment exceeded 3 days, with only 16/65 (25%) of these samples obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with Gram-positive bacteria on culture (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.17–4.2).
Conclusion: Dosing errors, prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions.
Contribution: The study identified multiple opportunities for improved vancomycin prescribing and monitoring. Further research and implementation of improved prescribing practices could contribute to the preservation of vancomycin as an effective antibiotic. |
| first_indexed | 2024-03-09T03:04:30Z |
| format | Article |
| id | doaj.art-f4a691f48e2a4a63a2c7407f743521ae |
| institution | Directory Open Access Journal |
| issn | 2312-0053 2313-1810 |
| language | English |
| last_indexed | 2024-03-09T03:04:30Z |
| publishDate | 2023-11-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of Infectious Diseases |
| spelling | doaj.art-f4a691f48e2a4a63a2c7407f743521ae2023-12-04T08:12:19ZengAOSISSouthern African Journal of Infectious Diseases2312-00532313-18102023-11-01381e1e710.4102/sajid.v38i1.528277A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape TownLeonore Greybe0Brian S. Eley1Hafsah D. Tootla2Anna M.M. Botha3Wisdom Basera4James J.C. Nuttall5Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape TownDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape TownDepartment of Medical Microbiology, Faculty of Pathology, National Health Laboratory Service (Red Cross War Memorial Children's Hospital), Cape TownDepartment of Pharmacy, Faculty of Health, Red Cross War Memorial Children’s Hospital, Cape TownSchool of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Burden of Disease Research Unit, South African Medical Research Council, Cape TownDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape TownBackground: Antimicrobial stewardship principles guide the clinical use of antimicrobials, including vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa. Objectives: To document the use, prescribing practices and monitoring of intravenous vancomycin and the spectrum of bacteria isolated on microbiological culture in children treated with intravenous vancomycin during a 12-month period at Red Cross War Memorial Children’s Hospital (RCWMCH). Method: A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019 was performed. Results: All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy per 1000 patient days (interquartile range [IQR]: 38–72). The median starting dose was 15 mg/kg per dose (IQR: 14–15) and median daily dose was 45 mg/kg per day (IQR: 43–60). Vancomycin was prescribed as empiric (127/158, 80%) and directed (31/158, 20%) treatment. The median duration of treatment for the directed group (7 days) was longer than the empiric group (4 days) (p = 0.001). Vancomycin serum trough concentrations were performed in 65/98 (66%) episodes where vancomycin treatment exceeded 3 days, with only 16/65 (25%) of these samples obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with Gram-positive bacteria on culture (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.17–4.2). Conclusion: Dosing errors, prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions. Contribution: The study identified multiple opportunities for improved vancomycin prescribing and monitoring. Further research and implementation of improved prescribing practices could contribute to the preservation of vancomycin as an effective antibiotic.https://sajid.co.za/index.php/sajid/article/view/528vancomycinpaediatricsamsantimicrobial stewardshipaudittdmtherapeutic drug monitoring |
| spellingShingle | Leonore Greybe Brian S. Eley Hafsah D. Tootla Anna M.M. Botha Wisdom Basera James J.C. Nuttall A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town Southern African Journal of Infectious Diseases vancomycin paediatrics ams antimicrobial stewardship audit tdm therapeutic drug monitoring |
| title | A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town |
| title_full | A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town |
| title_fullStr | A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town |
| title_full_unstemmed | A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town |
| title_short | A descriptive study of vancomycin use at Red Cross War Memorial Children’s Hospital, Cape Town |
| title_sort | descriptive study of vancomycin use at red cross war memorial children s hospital cape town |
| topic | vancomycin paediatrics ams antimicrobial stewardship audit tdm therapeutic drug monitoring |
| url | https://sajid.co.za/index.php/sajid/article/view/528 |
| work_keys_str_mv | AT leonoregreybe adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT brianseley adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT hafsahdtootla adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT annammbotha adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT wisdombasera adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT jamesjcnuttall adescriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT leonoregreybe descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT brianseley descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT hafsahdtootla descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT annammbotha descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT wisdombasera descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown AT jamesjcnuttall descriptivestudyofvancomycinuseatredcrosswarmemorialchildrenshospitalcapetown |