Vancomycin prescribing and therapeutic drug monitoring: Challenges of real clinical practice

Abstract

Background Vancomycin prescription and monitoring guidelines have been reported to be poorly followed by various centers. Aims Identifying barriers to compliance with vancomycin dosing and therapeutic drug monitoring guidelines (TDM) and possible ways to enhance compliance based on the healthcare providers’ (HCPs) perspective. Methods A qualitative study based on semi-structured interviews with HCP (physicians, pharmacists, and nurses) was conducted at two Jordanian Teaching Hospitals. Interviews were audio-recorded and analyzed through thematic analysis. The COREQ criteria for qualitative research were utilized to report the study findings. Results A total of 34 HCPs were interviewed. HCP perceived several factors as barriers to guideline recommendation compliance. Such factors included negative perception towards prescription guidelines, lack of knowledge regarding TDM guidelines, the hierarchy of medication management, work pressure, and ineffective communication among healthcare providers. Potential strategies to optimize guidelines adaptation included providing HCPs with more training and decision support tools in addition to activating the role of clinical pharmacists. Conclusions The main barriers to guideline recommendations uptake were identified. Interventions should address those barriers related to the clinical environment, including enhancing interprofessional communication related to vancomycin prescription and TDM, reducing workload and providing support systems, promoting educational and training programs, in addition to adopting guidelines suitable for the local environment.

Vancomycin associated acute kidney injury in patients with infectious endocarditis: a large retrospective cohort study

“…We previously conducted a meta-analysis including 19 studies with 2,598 patients from developed countries such as the United States, Japan, Australia, and New Zealand, and developing countries such as China and India, and showed that the mean vancomycin trough concentration attainment rate was 34.3% under the conventional physician-led model of care (Kunming et al, 2023). Factors contributing to the unsatisfactory status of monitoring under physician-led vancomycin TDM included negative perception towards prescription guidelines, lack of knowledge regarding TDM guidelines, the hierarchy of medication management, work pressure, and ineffective communication among healthcare providers (Abdel Jalil et al, 2023). Our further analysis showed that 64.6% (281) of the patients were given vancomycin at 1g q12 h, which was a conventional dose.…”