Evidence of inappropriate use of vancomycin in a University affiliated Hospital in Brazil

Objective - To evaluate the appropriateness of use of vancomycin in a Unive rsity affiliated Hospital in Brazil. Methods - One hundred sequential therapeutic courses of vancomycin were ret rospectively examined through a chart review. The prescriptions were evalua ted in terms of indication, use of critical process indicators, and use of outcome measurements according to an adapted version of the criteria recomm ended by the American Society of Health-System Pharmacists. Results - The indication for use was appropriate in 39% of the cases. Criti cal process indicators indicated frequent inappropriate use, mainly in rela tion to a low frequency of bacterial cultures (54%), infrequent determinati on of creatinine levels prior to therapy (57%), incorrect dosage (42%), inc orrect duration of therapy (63%), and infrequent determination of serum lev els of vancomycin (73%). It was impossible to evaluate outcome measurements , since data were not collected in most patients. Larger discrepancies betw een recommendation and practice were detected in Paediatrics and Paediatric Pneumology Services. Conclusion - The misuse of vancomycin in our hospital is very common accord ing to standard guidelines, demanding new policies of control in order to d iminish the possibility of the emergence of multi-resistant strains. Copyri ght (C) 1999 John Wiley & Sons, Ltd.