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.

OBJECTIVE: 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. METHOD: We evaluated the utilization of vancomycin over a 3-month period pre- and post-intervention using educational activity. RESULTS: 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). CONCLUSION: 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.

Intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration.

Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, is used in the treatment of cancer. It was the first clinically available angiogenesis inhibitor in the U.S. Recently, bevacizumab has been used by ophthalmologists in the intravitreal treatment of choroidal neovascularization in age-related macular degeneration. Since all published trials were less than one year in duration, including follow up, no conclusion can be drawn about the long-term safety and efficacy of intravitreal bevacizumab. In open-label studies, however, intravitreal bevacizumab has yielded marked improvements in visual acuity and central retinal thickness. Compounding pharmacists who are validated in aseptic compounding can prepare intravitreal bevacizumab from the available preservative-free phosphate-buffered intravenous solution using strict aseptic technique.