August 23, 2019
1 min read

Pharmacy’s role in antimicrobial stewardship reduces vancomycin monitoring

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Incorporating a pharmacy-driven partnership into one children’s hospital’s antimicrobial stewardship plan decreased therapeutic drug monitoring for children administered IV vancomycin without increasing the risk for later kidney injury, according to findings published in the Journal of the Pediatric Infectious Diseases Society.

Study researcher Jared Olson, PharmD, an adjunct professor of pediatrics at the University of Utah, told Infectious Diseases in Children that aggressive monitoring and dosing for patients is “unlikely to increase efficacy or avoid harm, yet result in a large amount of wasted drug, effort and lab draws.”

Olson and colleagues added that providers need antibiotic stewardship strategies that reduce unnecessary treatment and optimize vancomycin dosing.

A tertiary care pediatric hospital in Utah began a pharmacy-driven vancomycin collaborative practice agreement (CPA) in June 1, 2014.

Under the CPA, pharmacists were encouraged to delay therapeutic drug monitoring in patients with normal renal function for up to 72 hours and perform 2-point area under the concentration-time curve estimates for most infections.

“Our objective was to determine the effects of these interventions on monitoring, dosing and outcomes of intravenous vancomycin therapy” in infants aged 30 days and older between April 1, 2011, and Aug. 30, 2017, the researchers wrote.

Olson and colleagues included 2,379 courses before the CPA vs. 2,155 after the agreement was made. The CPA managed 87% of courses after the agreement was made, they said.

In adjusted interrupted time series analyses, the CPA’s implementation was associated with an initial change in the level of therapeutic drug monitoring of –0.265 (95% CI, –0.336 to –0.189) and an initial change in the level of dosage adjustments of –0.332 (95% CI, –0.506 to –0.163). Furthermore, the risk for kidney injury 1 year after administration decreased after using the CPA (OR = 0.695; 95% CI, 0.539-0.91).

“Similar CPAs can be implemented at other institutions,” Olson said. “Although other tools are available, we are happy to share our worksheet to estimate vancomycin AUC to facilitate implementation at other sites.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.