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Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore

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Abstract

Background Vancomycin therapeutic drug monitoring (TDM) is commonly performed to ensure safe and effective use of the antibiotic. Aim of Study To evaluate appropriateness of vancomycin TDM and its outcomes in Singapore General Hospital. Method A retrospective, cross-sectional study was conducted between 1 January 2014 and 28 February 2014 involving patients who received ≥ 1 dose of intravenous vancomycin with TDM. Patient demographics and relevant vancomycin TDM data were collected from medical records. Results Of 746 vancomycin troughs measured among 234 patients, 459 troughs (61.5%) were taken inappropriately, with a median time of 2.6 h (interquartile range 1.1–4.3) before the next scheduled dose. Inappropriate interpretation of vancomycin troughs resulted in 41 unnecessary dose suspensions, 24 dose changes, and 102 unchanged vancomycin doses. The cost incurred due to inappropriate interpretation and measurement after discontinuation of treatment was US$7286. No differences in rates of vancomycin related nephrotoxicity, ototoxicity, recurrent infection, development of infection secondary to vancomycin resistant microorganism and mortality were observed (p > 0.05). Conclusion This study highlighted a high incidence of inappropriate vancomycin TDM which has led to increased healthcare cost.

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Acknowledgements

We would like to thank Ms. Ang Xiao Hui for assisting with the data collection.

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Authors and Affiliations

  1. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore

    Jun Jie Benjamin Seng

  2. Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Mei Hui Amanda Yong, Zi Xin Peh, Jie Lin Soong & Mooi Heong Tan

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  1. Jun Jie Benjamin Seng
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  2. Mei Hui Amanda Yong
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  3. Zi Xin Peh
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  4. Jie Lin Soong
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  5. Mooi Heong Tan
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Correspondence to Jun Jie Benjamin Seng.

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Seng, J.J.B., Yong, M.H.A., Peh, Z.X. et al. Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore. Int J Clin Pharm 40, 977–981 (2018). https://doi.org/10.1007/s11096-018-0670-4

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  • DOI: https://doi.org/10.1007/s11096-018-0670-4

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