Original Research

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

Leonore Greybe, Brian S. Eley, Hafsah D. Tootla, Anna M.M. Botha, Wisdom Basera, James J.C. Nuttall
Southern African Journal of Infectious Diseases | Vol 38, No 1 | a528 | DOI: https://doi.org/10.4102/sajid.v38i1.528 | © 2023 Leonore Greybe, Brian S. Eley, Hafsah D. Tootla, Anna M.M. Botha, Wisdom Basera, James J.C. Nuttall | This work is licensed under CC Attribution 4.0
Submitted: 26 March 2023 | Published: 06 November 2023

About the author(s)

Leonore Greybe, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Brian S. Eley, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Hafsah D. Tootla, Department of Medical Microbiology, Faculty of Pathology, National Health Laboratory Service (Red Cross War Memorial Children's Hospital), Cape Town, South Africa
Anna M.M. Botha, Department of Pharmacy, Faculty of Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Wisdom Basera, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
James J.C. Nuttall, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: Antimicrobial stewardship principles guide the clinical use of antimicrobials, including 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).

Method: A retrospective audit of intravenous vancomycin use in children admitted to RCWMCH during 2019 was performed.

Results: All 158 vancomycin prescription episodes for 143 children were included. Overall usage of intravenous vancomycin was 63 days of therapy per 1000 patient days (interquartile range [IQR]: 38–72). The median starting dose was 15 mg/kg per dose (IQR: 14–15) and median daily dose was 45 mg/kg per 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 (7 days) was longer than the empiric group (4 days) (p = 0.001). Vancomycin serum trough concentrations were performed in 65/98 (66%) episodes where vancomycin treatment exceeded 3 days, with only 16/65 (25%) of these samples obtained before the fourth dose. Prolonged antibiotic treatment of 14 days or more was not associated with Gram-positive bacteria on culture (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.17–4.2).

Conclusion: Dosing errors, prolonged empiric treatment and inappropriate vancomycin monitoring were problems associated with vancomycin prescriptions.

Contribution: The 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

vancomycin; paediatrics; AMS; antimicrobial stewardship; audit; TDM; therapeutic drug monitoring

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