International Journal of Clinical Pharmacy

, Volume 34, Issue 2, pp 282–285 | Cite as

Short term impact of guidelines on vancomycin dosing and therapeutic drug monitoring

  • Maria SwartlingEmail author
  • Reetu Gupta
  • Vicky Dudas
  • B. Joseph Guglielmo
Short Research Report


Background After medical center implementation of 2009 ASHP/IDSA guidelines, we evaluated the appropriateness of vancomycin dosing and TDM. Objective Our primary objectives were to assess short term effects on (1) appropriateness of initial vancomycin dosing, (2) appropriateness of sampling of plasma levels, before and after implementation of guidelines. Method The study was conducted in two phases, pre-guideline and post-guideline implementation. The interventions included (1) Nurses and phlebotomist education regarding the appropriate timing of vancomycin sampling, (2) A nomogram for appropriate initial dosing that was distributed to medical staff. Patient demographics, dosing and timing of sampling were collected in eligible patients and assessed for appropriateness. Results The appropriateness of the prescribed dose increased from 51% (128/253) of patients during the pre period to 78% (155/200) (p < 0.0001) during the post period. Similarly, overall appropriateness of sampling of vancomycin troughs at steady state improved from 36% (63/173) pre to 55% (106/191) (p < 0.03) post. Specifically, the appropriate timing of troughs (within 30 min of the next dose) increased from 37% (64/173) during the pre period to 78% (149/191) during the post period (p < 0.0001). Conclusion Adoption of the guidelines with associated training resulted in significant short term improvement in vancomycin dosing and TDM


Appropriate use Education Guidelines Therapeutic drug monitoring TDM Vancomycin 



MS was supported by Swedish Academy of Pharmaceutical Sciences.

Conflicts of interest



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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Maria Swartling
    • 1
    Email author
  • Reetu Gupta
    • 2
  • Vicky Dudas
    • 3
  • B. Joseph Guglielmo
    • 2
  1. 1.Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
  2. 2.Department of Clinical Pharmacy, School of PharmacyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of Pharmaceutical ServicesUniversity of California San Francisco Medical CenterSan FranciscoUSA

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