Assessment of vancomycin use in chronic haemodialysis patients: room for improvement

Zvonar, Rosemary; Natarajan, Sabrina; Roth, Virginia

doi:10.1093/ndt/gfn343

Cited by 21 publications

(34 citation statements)

References 15 publications

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“…Vancomycin was prescribed empirically for most cases in the study, which was deemed an appropriate indication due to the risk of MRSA infections in this patient group. Other studies where vancomycin is prescribed empirically before culture and sensitivities are available have also reported that 80–88% of vancomycin doses or courses are appropriate [18, 19]. Yet, once culture and sensitivities are available, vancomycin is commonly classified as inappropriate due to not fitting the criteria for infection or for failing to prescribe a narrower spectrum antibiotic [8, 18, 19].…”

Section: Discussionmentioning

confidence: 99%

Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

et al. 2017

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BackgroundThere are limited published data on the types and appropriateness of oral and intravenous (IV) antibiotics prescribed to patients receiving haemodialysis. This information is critical to optimise antibiotic prescribing. Therefore this study aims to describe the patterns of use and the appropriateness of oral and IV antibiotics prescribed to patients receiving haemodialysis.MethodsThis was a prospective, observational study across four community and two hospital inpatient haemodialysis units in Melbourne, Australia. Data were collected from July 2014 to January 2015 from participants. Antibiotic regimens prescribed were compared with nationally available antibiotic guidelines and then classified as being either appropriate, inappropriate or not assessable by an expert multidisciplinary team using the National Antimicrobial Prescribing Survey tool.ResultsOverall, 114 participants consented to this study where 55.3% (63/114) received antibiotics and 235 antibiotic regimens were prescribed at a rate of 69.1 antibiotic regimens/100 patient-months. The most common oral antibiotics prescribed were amoxycillin/clavulanic acid and cephalexin. The most common IV antibiotics prescribed were vancomycin, piperacillin/tazobactam, cephazolin and ceftriaxone. The percentage of inappropriate antibiotic regimens prescribed were 34.9% (15/43) in the community setting and 22.1% (40/181) in the hospital setting. Furthermore, 29.4% (30/102) of oral and 20.5% (25/122) of IV antibiotic regimens were inappropriate with incorrect dosing as the primary reason.ConclusionAlthough this study is limited by the sample size, it describes the high antibiotic exposure that patients receiving haemodialysis experience. Of concern is inappropriate dose and frequency being a major issue. This requires interventions focused on the quality use of medicines and antimicrobial stewardship aspects of prescribing in this population.

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Section: Discussionmentioning

confidence: 99%

Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

et al. 2017

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“…Furthermore, Crawford and others, 23 who prospectively administered a single dose of vancomycin (35 mg/kg) at the end of dialysis, at a rate of 1 g/h, to 11 patients, reported that a once-weekly dose of vancomycin (35 mg/kg) did not achieve a vancomycin concentration of at least 10 mg/L before the third scheduled hemodialysis session. Zvonar and others 24 retrospectively evaluated 163 courses of vancomycin therapy in 105 patients at their institution and found that the most common dose was 500 mg after or during the hemodialysis session. Panais and others 25 administered a maximum loading dose of 1500 mg vancomycin in 38 courses, followed by 500 mg after each dialysis session and concluded that their protocol was successful in achieving a therapeutic trough concentration of the drug.…”

Section: Discussionmentioning

confidence: 99%

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Nekidy

El-Masri

Umstead

et al. 2016

CJHP

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Background: Methicillin-resistant Staphylococcus aureus is a leading cause of death in patients undergoing hemodialysis. However, controversy exists about the optimal dose of vancomycin that will yield the recommended pre-hemodialysis serum concentration of 15-20 mg/L. Objective: To develop a data-driven model to optimize the accuracy of maintenance dosing of vancomycin for patients undergoing hemodialysis. Methods: A prospective observational cohort study was performed with 164 observations obtained from a convenience sample of 63 patients undergoing hemodialysis. All vancomycin doses were given on the floor after completion of a hemodialysis session. Multivariate linear generalized estimating equation analysis was used to examine independent predictors of pre-hemodialysis serum vancomycin concentration. Results: Pre-hemodialysis serum vancomycin concentration was independently associated with maintenance dose (B = 0.658, p < 0.001), baseline pre-hemodialysis serum concentration of the drug (B = 0.492, p < 0.001), and interdialytic interval (B = -2.133, p < 0.001). According to the best of 4 models that were developed, the maintenance dose of vancomycin required to achieve a pre-hemodialysis serum concentration of 15-20 mg/L, if the baseline serum concentration of the drug was also 15-20 mg/L, was 5.9 mg/kg with interdialytic interval of 48 h and 7.1 mg/kg with interdialytic interval of 72 h. However, if the baseline pre-hemodialysis serum concentration was 10-14.99 mg/L, the required dose increased to 9.2 mg/kg with an interdialytic interval of 48 h and 10.0 mg/kg with an interdialytic interval of 72 h. Conclusions: The maintenance dose of vancomycin varied according to baseline pre-hemodialysis serum concentration of the drug and interdialytic interval. The current practice of targeting a pre-hemodialysis concentration of 15-20 mg/L may be difficult to achieve for the majority of patients undergoing hemodialysis.

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“…Erstens sollte deshalb die Gabe, wenn möglich, nach Dialyse erfolgen [16]. Zweitens sollte wie für Vancomycin gezeigt [17], auch bei anderen Antibiotika zusätzlich zur Erhaltungsdosis eine Supplementärdosis nach der Dialyse gegeben werden um die antimikrobielle Wirksamkeit zu gewährleisten.…”

Section: Dosisanpassung Bei Nierenersatztherapieunclassified

Umfrage zur Arzneimitteldosierung bei Niereninsuffizienz unter nephrologisch tätigen Ärzten

Maus

Holch

Czock

et al. 2010

Wien Klin Wochenschr

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Assessment of vancomycin use in chronic haemodialysis patients: room for improvement

Cited by 21 publications

References 15 publications

Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study

Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

Umfrage zur Arzneimitteldosierung bei Niereninsuffizienz unter nephrologisch tätigen Ärzten

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