Drug Utilization Review of Vancomycin in Febrile Neutropenic Patients Hospitalized at a Bone Marrow Transplantation Center

Abstract

Introduction: Infections in neutropenic patients are considered as major causes of mortality and emergence of drug resistant Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including methicillin resistant Staphylococcus aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent.
Methods: We conducted a prospective observational study at bone marrow transplantation research center, Shariati teaching hospital in Tehran to evaluate the appropriateness of vancomycin utilization for our adult bone marrow transplantation (BMT) patients for a period of six months.
Results: The charts of a total of 117 patients were prospectively reviewed in 3 adult BMT wards. Seventy four patients (63.2%) received vancomycin treatment during their hospital stay. Most patients received allogienic versus autologous transplantation (62.2%, 18.9%). Majority of patients were under 50 years of age (91.9%). About 58% of cases were febrile neutropenic at the time of vancomycin initiation. Based on the criteria of appropriate indications, vancomycin utilization was justified in 59.5% of cases which 43.2% of those cases received appropriate initial doses.
Conclusion: Based on the results of this study, in the majority of our BMT patients vancomycin was utilized appropriately as a part of their empiric treatment. More attention in the time of initiation and also dose adjustment seems to be necessary to minimize treatment failure and the emergence of drug resistance.