Vancomycin and teicoplanin use in Victorian hospitals

Objective: To determine patterns of prescribing of glycopeptide antibiotics (vancomycin and teicoplanin) in Victorian hospitals and identify areas for targeted intervention. Design: A concurrent, observational, multisite evaluation of drug use. Setting: Thirty-five Victorian hospitals, 1-14 September 1997. Study population: Patients commencing a glycopeptide antibiotic course. Main outcome measures: Rate of glycopeptide antibiotic use; indications; du ration of use; main hospitals using glycopeptide antibiotics. Results: 293 patients (269 adults and 24 neonates) commenced on 302 glycope ptide antibiotic courses: 296 intravenous (IV) vancomycin courses and three each of oral vancomycin and parenteral teicoplanin. The overall rate of us e was 10.3 courses per 1000 inpatient separations. Of 271 IV vancomycin cou rses for adults, 176 (65%) were for treatment - 120 empirically. The median duration of treatment courses was 4.7 days (interquartile range, 2.0-8.2 d ays). A flucloxacillin-resistant organism was confirmed for 44% of treatmen t courses. Ninety-five IV vancomycin courses were for prophylaxis, includin g for cardiac (54%) and vascular surgery (21%); 82% of prophylactic courses were administered for less than 24 hours. Of all the glycopeptide antibiot ic courses, 69% were administered at five major metropolitan hospitals. Conclusions: Glycopeptide antibiotic use in Victoria is concentrated in the major metropolitan hospitals. Prolonged durations of vancomycin therapy, i ncluding for surgical prophylaxis and empirical therapy not subsequently co nfirmed by microbiology findings, would be suitable targets for interventio nal strategies.