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

Objective - To evaluate the appropriateness of use of vancomycin in a University affiliated Hospital in Brazil. Methods - One hundred sequential therapeutic courses of vancomycin were retrospectively examined through a chart review. The prescriptions were evaluated in terms of indication, use of critical process indicators, and use of outcome measurements according to an adapted version of the criteria recommended by the American Society of Health-System Pharmacists. Results - The indication for use was appropriate in 39% of the cases. Critical process indicators indicated frequent inappropriate use, mainly in relation to a low frequency of bacterial cultures (54%), infrequent determination of creatinine levels prior to therapy (57%), incorrect dosage (42%), incorrect duration of therapy (63%), and infrequent determination of serum levels of vancomycin (73%). It was impossible to evaluate outcome measurements, since data were not collected in most patients. Larger discrepancies between recommendation and practice were detected in Paediatrics and Paediatric Pneumology Services. Conclusion - The misuse of vancomycin in our hospital is very common according to standard guidelines, demanding new policies of control in order to diminish the possibility of the emergence of multi-resistant strains. Copyright (C) 1999 John Wiley & Sons, Ltd.