Utilization pattern of vancomycin in a University Teaching Hospital in Oman: Comparison with international guidelines

Purpose: To assess the prescribing and utilization pattern of vancomycin in Sultan Qaboos University Hospital (SQUH) in Oman. Methods: A retrospective study that included in-patients at SQUH who had used vancomycin from January 1 2009 to December 31 2009 was conducted to determine the utilization patterns of the drug vis a vis to the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and the North American Therapeutic Drug Monitoring Consensus (NATDMC) recommendations. Information regarding patient characteristics and vancomycin therapy were obtained from patients' medical records. Statistical analyses were performed using descriptive statistics. Results: Out of 478 prescriptions for 365 patients, 79.1 % were considered inappropriate, based on HICPAC guidelines. This was mainly due to the continuous use of vancomycin following negative microbiological cultures for β-lactam-resistant Gram-positive microorganisms. Vancomycin was prescribed mostly for treatment of sepsis (27.1 %), followed by prophylaxis against various clinical conditions (20.8 %). Therapeutic drug monitoring (TDM) practices at SQUH did not comply with NATDMC recommendations on the use of trough concentration in the specified range as a guide for monitoring of therapy. Conclusion: Irrational use of vancomycin was recorded in this study. The need for a restrictive policy and a revision of the current TDM in the setting are recommended.