A descriptive study of vancomycin usage at Red Cross War Memorial Children's Hospital, Cape Town

Greybe, Leonore

A descriptive study of vancomycin usage at Red Cross War Memorial Children's Hospital, Cape Town

Thesis / Dissertation

2023

Abstract

Background: Antimicrobial stewardship principles guide the clinical use of vancomycin, but paediatric vancomycin prescribing practices have not been evaluated in South Africa. Objectives: To document the use, prescribing practices and monitoring of intravenous vancomycin and the spectrum of bacteria isolated on microbiological culture in children treated with intravenous vancomycin during a 12-month period at Red Cross War Memorial Children's Hospital (RCWMCH). Methods: A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019. Results: All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy/1000 patient days (IQR 38–72). The median starting dose was 15 mg/kg/dose (IQR 14 ̶ 15) and median daily dose was 45 mg/kg/day (IQR 43–60). Vancomycin was prescribed as empiric (127/158, 80%) and directed (31/158, 20%) treatment. The median duration of treatment for the directed group was longer than the empiric group (p=0.001). Only 65/98 (66%) episodes where vancomycin treatment exceeded three days had vancomycin serum trough concentrations performed, and only 16/65 (25%) of these samples were obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with gram positive bacteria on culture (OR 1.02, 95% CI 0.17 ̶ 4.2). Conclusion: Prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions. Contribution: Our study identified multiple opportunities for improved vancomycin prescribing and monitoring. Further research and implementation of improved prescribing practices could contribute to the preservation of vancomycin as an effective antibiotic.

Keywords

Paediatrics and Child Health

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