The following is a summary of “Vancomycin use for haemodialysis patients—Development of a new dosing protocol,” published in the April 2023 issue of Nephrology by Ho, et al.
Researchers sought to develop a dosing and monitoring protocol for a study to achieve therapeutic vancomycin levels in patients receiving intermittent hemodialysis.
Fifteen vancomycin treatment courses of patients on intermittent hemodialysis at a district health board were identified. Demographic, biochemical, and clinical parameters were collected from their health records. A new vancomycin protocol was devised and implemented, which included a weight-based loading dose and subsequent dose titration based on same-day measured pre-dialysis levels. Sixteen vancomycin treatment courses were re-audited to assess the performance of the protocol.
Following the implementation of the protocol, a significantly higher proportion of vancomycin levels were within the target range (15-20 mg/L), increasing from 23% to 46% (P < 0.005). In addition, a greater proportion of treatment courses had more than 50% of pre-dialysis levels within the target range, increasing from 13% to 56% (P < 0.01). The number of withheld doses of vancomycin during treatment decreased from 19 out of 117 doses in the pre-protocol group to 1 out of 118 doses in the post-protocol group. Approximately 62% of total maintenance doses were administered according to the protocol. Implementing the protocol also reduced hospital stay length and fewer positive blood cultures during treatment.
The initial audit revealed deficiencies in clinical practice regarding vancomycin dosing and monitoring for patients on intermittent hemodialysis. The implementation of the novel protocol led to improvements in achieving therapeutic vancomycin levels and reduced the number of withheld doses. However, the sample size was small, and further studies were needed to evaluate the clinical outcomes associated with the protocol.