The Scottish model of vancomycin dosing and therapeutic drug monitoring improves both efficacy and safety of vancomycin therapy.

OBJECTIVE: Vancomycin therapeutic drug monitoring (TDM) is recommended for better treatment efficacy and safety. The Scottish Antimicrobial Prescribing Group model recommends weight-based loading dose, next 3-4 doses based on creatinine clearance and maintenance doses according to trough concentrations. METHODS: Retrospective cohort study of all adult patients treated with vancomycin before and after introducing the guideline in a large Czech hospital in 2015 compares the success rate in achieving recommended trough concentrations (10-20 mg/l) during first measurement and efficiency of maintaining these concentrations subsequently. Assessment of vancomycin related nephrotoxicity is included. RESULTS: In 2014, 74/163 (45.4 %) patients achieved recommended concentrations in the first measurement, compared to 101/160 (63.1 %) patients in 2016 (χ2; p = 0.001). Recommended trough concentrations in more than half of subsequent measurements were detected in 51/105 patients (48.6 %) in 2014 and in 80/117 patients (68.4 %) in 2016. Not a single level in subsequent measurements within the range was detected in 28 (26.7 %) cases in 2014 and in 10 (8.5 %) cases in 2016 (Mann-Whitney; p = 0.026). There was no difference in nephropathy occurrence (χ2; p = 0.286). CONCLUSION: The adopted Scottish model of vancomycin TDM resulted in very significantly higher achievement of recommended trough concentrations during first measurements and significantly more effective maintenance of subsequent concentrations, without increased nephrotoxicity. Key words: guideline - therapeutic drug monitoring - vancomycin.

Hospital antibiotic management in the Czech Republic--results of the ABS maturity survey of the ABS International group.

BACKGROUND: Hospital antibiotic stewardship (ABS) programs are essential for ensuring long-lasting quality of antibiotic usage and for controlling antimicrobial resistance in the hospital setting. METHODS: A questionnaire for self-assessment of a hospital's ABS maturity was sent to 80 Czech hospitals in May 2007. The survey was focused on diagnostic issues, control of antibiotic consumption, antibiotic-related organization and tools, antibiotic-related personnel development and antibiotic-related relationships to relevant environments. RESULTS: Of 80 addressed hospitals, 45 sent back processed questionnaires (response rate 56.3%). These 80 hospitals cover about 85% of the Czech population. All Czech university hospitals were included in the replying group. The listed diagnostic tools were declared available by all hospitals; 44 of 45 hospitals have surveillance systems for antibiotic resistance rates. Control of antibiotic consumption was available only partially in 42 of 45 hospitals. Some antibiotic tools need to be improved and must be used more frequently. Official recognition, job descriptions and better funding of antibiotic personnel are needed, as well as support for further development of ABS structures and functions. DISCUSSION: The basic structure of ABS is well developed in the Czech hospitals. A network of antibiotic centers focusing their services on optimization of antibiotic usage has been in place in the Czech Republic since the 1970s. Nevertheless, the survey revealed a clear need and many opportunities for further improvement. Control of antibiotic consumption is not implemented in all Czech hospitals and some of the essential antibiotic tools should be used more widely.