Restriction of vancomycin use in a German university hospital

Background: Recently, increasing antibiotic resistance has been observed am ong gram-positive bacteria. However, only few isolates were found to be res istant against glycopeptides. Therefore, internationally accepted guideline s recommend a restricted use of vancomycin and other glycopeptide antibioti cs in order to prevent the development of resistance against these clinical ly important antibiotics. In many countries, the hospital pharmacies play a key role ol and reinforcement of antibiotic formulary restrictions. In Ger many, however, the hospital pharmacies usually do not take over such contro l functions, and most wards keep a stock of regularly used drugs including antibiotics, rich makes reinforcement of restrictions difficult. Methods: In an attempt to achieve a restriction of vancomycin use, tie phar macy of our university hospital was advised Co deliver vancomycin to the wa rds only on request with a special order form signed by an attending, indiv idually for every patient who should receive vancomycin. The efficacy of th is restriction measure was evaluated in 3-month periods before and after th e restriction became effective. Results: Hospitalwide, this led to a 20.1% reduction of i. v. vancomycin an d an 85.7% reduction of oral vancomycin use per 1000 patient days. If the h ematology/oncology units were not considered, the reduction of i. v. vancom ycin use was 41.8%, and the total use after the restriction 24.2 g. per 100 0 patient days. Microbiology results which justified the use of vancomycin decreased by 8.3% (10.9% hematology/oncology units not considered) between the 2 observation periods. Assuming a 7-day mean course of i. v. vancomycin therapy, the empirical of i. v. vancomycin decreased from 39.9% to 8% afte r the restriction had been instituted. Conclusion: Allowing only experienced physicians (attendings) to decide on the use of vancomycin therapy, proved in our experience to br an effective measure to reduce unnecessary vancomycin use.