title: Improvement in vancomycin utilization in adults in a Saudi Arabian Medical Center using the Hospital Infection Control Practices Advisory Committee guidelines and simple educational activity.
abstract: OBJECTIVE
  To evaluate vancomycin utilization according to the adapted criteria of the Centers for Disease Control and Prevention (CDC) with a report of the effect of education program on the utilization.
  
  
  METHODS
  We evaluated the utilization of vancomycin over a 3-month period pre- and post-intervention using educational activity.
  
  
  RESULTS
  In the pre-intervention period, of the 74 adult patients vancomycin was prescribed for specific treatment in 66% (n=49), empirical therapy in 26% (n=19) and as a prophylaxis in 8% (n=6). Vancomycin utilization was considered appropriate based on the CDC recommendations in 48 (65%) patients. Forty-seven (64%) patients received an appropriate dose regimen based on weight, age and creatinine clearance. Only 31% (n=23) of patients had both peak and trough levels taken around the third dose. In the post-intervention period, vancomycin was used as specific therapy in 41% (n=14) and empirically in 59% (n=20). Compliance with guidelines for empirical use of vancomycin improved from 21% in the pre-intervention phase to 85% after the intervention (P=.0001). In addition, compliance with vancomycin use in specific therapy was 100% compared to 82%. Compliance rate with vancomycin trough level monitoring increased from 35% in the pre-intervention period to 67.7% in the post-intervention period (P=0.0002).
  
  
  CONCLUSIONS
  In conclusion, in addition to the utilization of CDC based criteria for vancomycin, we had shown that patient's chart review by a clinical pharmacists with a feed back to the physicians when guidelines were not met coupled with and educational efforts are effective methods to decrease inappropriate vancomycin usage.
authors.affiliation: Pharmacy Services Division, Saudi Aramco Medical Services Organization, Saudi Aramco, Saudi Arabia.
authors.forename: Jean G
authors.initials: JG
authors.lastname: Dib
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.forename: Saud
authors.initials: S
authors.lastname: Al Abdulmohsin
authors.forename: Khurram
authors.initials: K
authors.lastname: Mohammed
authors.forename: Phyllis D
authors.initials: PD
authors.lastname: Jenden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000097:blood / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000517:prevention & control*; D004363:Drug Utilization; D004502:Education, Medical, Continuing; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012529:Saudi Arabia; D013203:Staphylococcal Infections / Q000517:prevention & control; D014481:United States; D014640:Vancomycin / Q000097:blood / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin