title: Evaluation of a Once-Daily Vancomycin Regimen in an Outpatient Leukemia/Bone Marrow Transplant Clinic (OD-VANCO Study).
abstract: BACKGROUND
  The Leukemia/Bone Marrow Transplant Program of British Columbia manages patients with high-risk febrile neutropenia and those with non-neutropenic immunocompromised states in an outpatient clinic setting. Because the program treats outpatients only, once-daily administration of IV antibiotics is desirable. A high-dose, once-daily vancomycin nomogram was developed and implemented as part of the antibiotic treatment regimen.
  
  
  OBJECTIVE
  To determine if therapeutic vancomycin trough levels could be achieved with a high-dose, once-daily regimen in this outpatient setting.
  
  
  METHODS
  A prospective, single-centre, observational cohort study was conducted over a 7-month period. Outpatients in the Leukemia/Bone Marrow Transplant Program were started on IV vancomycin with the high-dose, once-daily vancomycin nomogram, and outcomes were assessed.
  
  
  RESULTS
  Of 48 outpatients treated over the 7-month period, 10 (21%) had therapeutic vancomycin trough concentrations (i.e., greater than 10 mg/L). Thirty-five (90%) of the 39 patients with suspected clinical infection experienced clinical cure, and 6 (67%) of the 9 patients with documented microbiological infection experienced microbiological cure. Thirty (62%) of the 48 patients experienced symptoms of "red man syndrome", and 7 (15%) experienced some degree of nephrotoxicity. Two of 3 patients with laboratory-reported minimum inhibitory concentration (MIC) for identified pathogens had a calculated area under the curve to MIC ratio greater than or equal to 400.
  
  
  CONCLUSIONS
  The high-dose, once-daily vancomycin nomogram was effective in attaining trough levels greater than 10 mg/L in only 21% of patients in this study. A substantial number of adverse drug reactions were observed. Given these results, high-dose, once-daily vancomycin is no longer recommended for outpatient therapy.
authors.affiliation: BSc(Pharm), ACPR, is a Clinical Pharmacist at Vancouver General Hospital and a Clinical Instructor in the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Luo
authors.affiliation: BSc(Pharm), ACPR, PharmD, is a Pharmacotherapeutic Specialist, Solid Organ Transplantation, Vancouver General Hospital, and a Clinical Instructor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Trana
authors.initials: T
authors.lastname: Hussaini
authors.affiliation: BSc, BSc(Pharm), ACPR, is a Clinical Pharmacist, Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, and a Clinical Instructor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Katie
authors.initials: K
authors.lastname: Lacaria
authors.affiliation: BSc(Pharm), ACPR, PharmD, is Coordinator, Lower Mainland Pharmacy Services Pharmacy Practice Residency Program; a Pharmacotherapeutic Specialist, Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital; and a Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Janice
authors.initials: J
authors.lastname: Yeung
authors.affiliation: PharmD, ACPR, FCSHP, is a Pharmacotherapeutic Specialist, Infectious Diseases and Antimicrobial Stewardship, Vancouver General Hospital, and is also a Clinical Professor, Faculty of Pharmaceutical Sciences, and an Associate Member, Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Tim T Y
authors.initials: TT
authors.lastname: Lau
authors.affiliation: MBChB, FRACP, is Director, Ambulatory Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, and Clinical Associate Professor, Division of Hematology, The University of British Columbia, Vancouver, British Columbia.
authors.forename: Raewyn C
authors.initials: RC
authors.lastname: Broady
keywords: febrile neutropenia; nomogram; once-daily vancomycin; therapeutic drug monitoring