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Purpose: Vancomycin (VAN) remains a mainstay for the treatment of serious infections caused by gram-positive organisms. The purpose of this study was to assess if pharmacist managed therapy can produce timely therapeutic levels at least as effectively as physician managed dosing of VAN.
Methods: A total of 100 patients were evaluated for baseline characteristics. Demographic, laboratory and VAN monitoring data were collected. Percentage of patients with initial, second, and third levels within subtherapeutic (<10 mg/l), therapeutic (10 to 20 mg/l) and supratherapeutic (>20 mg/l) ranges were compared. Secondary end points included comparing initial mean ± SD VAN concentrations, levels between 8 and 22 mg/l, percentage of patients never reaching concentrations of ≥10 mg/l, and time to reach the therapeutic range.
Results: There were no statistically significant differences in baseline characteristics between the two groups evaluated. VAN levels within the therapeutic range for initial, second and third measurements were 77%, 71%, 74% for pharmacist managed therapy and 37%, 58%, 55% for the comparator. Initial mean ± SD VAN levels were 13.4 ± 3.6 mg/l and 8.8 ± 3.9 mg/l (p <0.05), while levels between 8 and 22 mg/l were 88% and 63%, for the intervention and comparator groups, respectively. An additional 40% of patients never reached 10 mg/l in the physician group compared to the intervention group. Median ± SD number of days to reach therapeutic range was 1.9 ± 0.9 days for the intervention group versus 2.5 ± 2.7 days for the comparator group (p <0.05).
Conclusion: Pharmacist managed VAN therapy resulted in both a greater percentage of therapeutic levels and a shorter time to reach therapeutic range. Consequently, the pharmacist managed VAN therapy appears to be at least as or more effective in achieving pre-specified laboratory endpoints when compared to physician dosing of VAN at our institution.