Improvement in vancomycin utilization in adults in a Saudi Arabian medical center using the hospital infection control practices advisory committee guidelines and simple educational activity

To evaluate vancomycin utilization according to the adapted criteria of the Centers for Disease Control and Prevention [CDC] with a report of the effect of education program on the utilization. We evaluated the utilization of vancomycin over a 3-month period pre- and post-intervention using educational activity. In the pre-intervention period, of the 74 adult patients vancomycin was prescribed for specific treatment in 66% [n = 49], empirical therapy in 26% [n = 19] and as a prophylaxis in 8% [n = 6]. Vancomycin utilization was considered appropriate based on the CDC recommendations in 48 [65%] patients. Forty-seven [64%] patients received an appropriate dose regimen based on weight, age and creatinine clearance. Only 31% [n = 23] of patients had both peak and trough levels taken around the third dose. In the post-intervention period, vancomycin was used as specific therapy in 41% [n = 14] and empirically in 59% [n = 20]. Compliance with guidelines for empirical use of vancomycin improved from 21% in the pre-intervention phase to 85% after the intervention [P = .0001]. In addition, compliance with vancomycin use in specific therapy was 100% compared to 82%. Compliance rate with vancomycin trough level monitoring increased from 35% in the pre-intervention period to 67.7% in the post-intervention period [P = 0.0002]. In conclusion, in addition to the utilization of CDC based criteria for vancomycin, we had shown that patient's chart review by a clinical pharmacists with a feed back to the physicians when guidelines were not met coupled with and educational efforts are effective methods to decrease inappropriate vancomycin usage

National Cholesterol Education Panel III performance in preventing myocardial infarction in young adults

Only one published trial has directly evaluated the utility of the new National Cholesterol Education Program [NCEP] guidelines in young adults and that study population consisted of young Americans. We examined the utility of the latest NCEP Adult Treatment Panel III [ATP III] guidelines in a group of young Lebanese adults. A group of 234 young adults admitted for myocardial infarction at a Lebanese teaching hospital over a 2-year period were evaluated retrospectively. The Framingham risk predictor model was used to calculate the 10-year risk for coronary events in all subjects. Two hundred young Lebanese adults with a mean age of 49.7 +/- 7.6 years were included in the analysis. The majority of the study population had a history of smoking [67%] and LDL cholesterol <130 mg/dL [70.5%] and were considered overweight and obese [80.5%]. As a group, 80% did not meet the criteria to qualify for antilipemic pharmacotherapy prior to their presentation. The predictive model did not detect the majority of these patients. Clinicians should treat modifiable risk factors with the same intensity given to cholesterol even if the patient has a normal lipid profile