None listed
Conditions
Brief summary
Vancomycin is an intravenous antibiotic used in the treatment of serious infections, commonly seen in the Intensive and Critical Care Unit (ICCU). Unlike many antibiotics, vancomycin requires serum drug concentration monitoring to ensure both efficacy and safety. Traditionally vancomycin is dosed as an intravenous intermittent infusion every 8-12 hours. However, critically ill patients experience greater pharmacokinetic changes which can have a major impact on the dosage of vancomycin required to treat infection. There is emerging evidence to suggest that the administration of vancomycin by a continuous infusion may be more efficacious in achieving therapeutic serum concentrations, doing so promptly, and limiting nephrotoxicity which is a known adverse effect of the drug. The aims of this project are as follows 1. To evaluate the current practice administering vancomycin by intermittent infusion within the ICCU at Flinders Medical Centre (FMC)- phase one/Before 2. To develop and implement a protocol for the administration of vancomycin by continuous infusion- phase two/Implementation 3. By using a Before-and-After study design evaluate the efficacy of a protocol for the administration of vancomycin by continuous infusions, when compared to standard practice within the ICCU at FMC- phase three/After Data on the current practice of vancomycin dosing via intermittent infusion was commenced in February 2015, this data formed the basis for the Before group. The protocol was developed, using a dosing nomogram derived from a series of published studies identified from a literature review on the topic. This protocol underwent beta-testing and was implemented into the ICCU in March 2016 with concurrent education sessions. Prospective post-implementation data collection was undertaken, making up the After group.
Interventions
This study is a before/after study design
The after phase begins after the implementation of a protocol for continuous intravenous infusions of vancomycin. This protocol consists of an intravenous infusion of a 25mg/kg loading dose, based on actual body weight, followed by a continuous infusion of vancomycin with initial dosing rates dictated by a protocol driven daily assessment of renal function using an estimated creatinine clearance. This protocol also involves daily therapeutic drug monito
This study is a before/after study design The after phase begins after the implementation of a protocol for continuous intravenous infusions of vancomycin. This protocol consists of an intravenous infusion of a 25mg/kg loading dose, based on actual body weight, followed by a continuous infusion of vancomycin with initial dosing rates dictated by a protocol driven daily assessment of renal function using an estimated creatinine clearance. This protocol also involves daily therapeutic drug monitoring. Creatinine clearance as per Cockcroft-Gault (Column 1) Total dose over 24 hours (Column 2) Infusion rate (Column 3) Less than 10mL/min 10-21mL/min 750mg 3.8mL/hour 22-39mL/min 1000mg 5 mL/hour 40-57mL/min 1250mg 6.3 mL/hour 58-75mL/min 1500mg 7.5 mL/hour 76-93mL/min 1750mg 8.8 mL/hour 94-111mL/min 2000mg 10 mL/hour 112-129mL/min 2250mg 11.3 mL/hour 130-147mL/min 2500mg 12.5 mL/hour 148-165mL/min 2750mg 13.8 mL/hour Greater than or equal to 166mL/min 3000mg 15 mL/hour This data collection takes place over 7 months
Sponsors
Mr Simon Potts
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- At least 24 hours of intravenous vancomycin therapy - At least one serum vancomycin concentration measured
Exclusion criteria
- Non-intravenous vancomycin (ie. oral) - Breastfeeding patients - Pregnant patients
Outcome results
None listed