Assessment of a Vancomycin Dosing Protocol in Obese Patients

Abstract

Specific Aims: To identify the percentage of obese patients who received subtherapeutic doses of vancomycin at a single community medical center using a standardized dosing algorithm. Methods: A single-center, retrospective chart review was performed analyzing data from the records of 100 patients who received an initial vancomycin dose with a trough drawn after 24 hours of the initial dose. Data was collected at a 170-bed community medical center. The facility’s electronic health record (EHR), was used to extract data from patient charts. The first 100 patients that qualified between 01/01/2017 and 06/30/2017 were used for analysis. Main Results: The results of the study demonstrated that 52% of all patients achieved subtherapeutic trough concentrations. A vancomycin dose given within +/- 1 hour of its scheduled time (P = 0.0000094) was found to be associated with attaining a desired trough goal. A 95% confidence interval of 38.46 to 58.22% for non-therapeutic trough levels was calculated via the Adjusted Wald Method. Conclusion: Algorithms for vancomycin dosing may not be reliable tools for the dosing of this medication in obese persons. Individualized dosing in this population remains essential for the optimal treatment of infection in this cohort of patients.