Implications of Vancomycin Troughs Drawn Earlier Than Current Guidelines
A study conducted in Australia demonstrated that pharmacist-led education of vancomycin dosing and monitoring (including when to measure a trough level) among prescribers and nurses led to improved adherence to the current guidelines and a greater number of patients treated within desired therapeutic ranges.9 In addition, a small study at the Atlanta VAMC in Georgia demonstrated that education of nurses, lab personnel, residents, ward clerks, and pharmacists led to a greater number of appropriately timed vancomycin and aminoglycoside levels.10 Thus, an interdisciplinary review of the current IDSA guidelines and review on the publication of the anticipated updated vancomycin guidelines should be provided to hospital personnel to aid in adoption of current dosing and monitoring recommendations.11
Limitations
This study is limited by the 4-year span of time that it encompassed, which may give a skewed depiction of current practices. Another limitation is that patients with fluctuating renal function were included in the analysis. Instead of selecting a random level order, a trough level order was sometimes selected for these patients. This could lead to a lower actual rate of early troughs. A third limitation is that this was a small and unblinded study. Also, the actual trough levels and the resulting changes that were made to specific regimens were not recorded. Thus, these data do not indicate whether the changes that were made reflected guideline recommendations. Finally, some clinical actions were taken after the dosing interval following the trough. This was often a result of off-hours lab results or waiting on attending physician or infectious disease guidance. These data were not included in the analysis.
Conclusion
Vancomycin troughs were often drawn too early and resulted in an increased rate of trough recollection. In an attempt to improve adherence to the current and the upcoming revised version of the IDSA consensus statement, it is recommended to educate and reeducate providers through interdisciplinary-led review sessions.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
