Evaluation of Weight-based Dosing of Vancomycin in Hospitalized Patients at a District Hospital in Nakhon Si Thammarat: A Descriptive Retrospective Study
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Abstract
Vancomycin, a glycopeptide antibiotic, is widely used to treat severe gram-positive infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). Its narrow therapeutic index and variable pharmacokinetics make dosing challenging, especially in resource-limited hospitals where therapeutic drug monitoring (TDM) is unavailable. This study evaluates the appropriateness of vancomycin dosing and factors contributing to deviations from recommended regimens.
This retrospective study was conducted at a district hospital in Nakhon Si Thammarat, Thailand, from January 2012 to August 2015. Seventy-one patients receiving vancomycin were included. Demographic, clinical, and dosing data were collected from medical records. Regimens were categorized as therapeutic, subtherapeutic, or supratherapeutic based on established guidelines. Chi-square and Fisher’s exact tests assessed associations between dosing adequacy and patient characteristics.
Among 78 regimens analyzed, 55.1% achieved therapeutic levels, while 44.9% were outside the target range (16.7% subtherapeutic, 28.2% supratherapeutic). The 15–20 mg/kg/dose regimen, the most frequently used, showed significant subtherapeutic dosing (44.4%, p < 0.05), particularly in patients >67 kg. The 500 mg HD regimen exhibited the highest rate of supratherapeutic dosing (76.9%, p < 0.05), highlighting challenges in post-hemodialysis dosing. Pediatric patients on the 10–15 mg/kg/dose regimen achieved therapeutic levels in 75% of cases, though 25% had supratherapeutic levels (p < 0.05).
This study underscores the need for individualized vancomycin dosing, adherence to evidence-based protocols, and expanded TDM access, particularly for high-risk groups like pediatric and hemodialysis patients. Standardized guidelines and real-time monitoring could improve therapeutic outcomes and reduce toxicity risks.
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