title: Safety and Outcome of Pharmacy-Led Vancomycin Dosing and Monitoring.
abstract: BACKGROUND
  Therapeutic vancomycin trough levels correlate with therapeutic success and the development of renal failure. In this study, we aimed to describe the safety and outcome of pharmacy-led vancomycin dosing and monitoring.
  
  
  METHODS
  We included adults requiring vancomycin for >48 h and who had a vancomycin trough level drawn near steady state. The primary outcome of the comparison was the achievement of therapeutic trough levels, defined as 10-20 µg/ml. Secondary outcome included acute renal failure. We compared these outcomes before and after the implementation of pharmacy-led vancomycin dosing and monitoring.
  
  
  RESULTS
  During the study period, a total of 278 patients were in the preimplementation phase and 286 were in the postintervention phase. There was a clear increase in the percentage of patients achieving the therapeutic range (50.5 vs. 79.7%, p = 0.0001) and an increase in the percentage of levels within the therapeutic range (31.6 vs. 59.1%; p = 0.0001). The number of cases receiving vancomycin increased by 5% and the duration of therapy decreased by 19.5%. More patients attained a therapeutic range of 10-20 µg/ml (i.e. the level was 31.6% in the preintervention and 59.1% in the postintervention phase).
  
  
  CONCLUSIONS
  A higher percentage of patients achieved a therapeutic range and less nephrotoxicity when using a pharmacy-led protocol for vancomycin dosing.
authors.forename: Hisham
authors.initials: H
authors.lastname: Momattin
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zogheib
authors.forename: Ali
authors.initials: A
authors.lastname: Homoud
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D011785:Quality Assurance, Health Care; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin