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2025-10-17
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Copyright (c) 2025 Rohidayah Abd Majid, Pei San Err, Nurul Fazleen, Mohd Afif Syazani Sulaiman, Nur Fatin Afiqah Fakhrul Anwar, Muhammed Luqmanulhakim Abu Bakar
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The adequacy of vancomycin initial dosing in CRBSI for hemodialysis patients in a specialized district hospital of Malaysia
Rohidayah Abd Majid
https://orcid.org/0009-0008-9916-1248
Pei San Err
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
https://orcid.org/0009-0003-7123-1236
Nurul Fazleen Abdul Malik
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
Mohd Afif Syazani bin Sulaiman
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
Nur Fatin Afiqah Fakhrul Anwar
Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
Muhammed Luqmanulhakim Abu Bakar
Pharmacy Department, Bakri Health Clinic, Muar, Johor, Malaysia
DOI: https://doi.org/10.24926/iip.v16i3.6757
Keywords: vancomycin, catheter-related bloodstream infections, hemodialysis, therapeutic drug monitoring, dosing adequacy, Methicillin-Resistant Staphylococcus aureus (MRSA)
Abstract
Background: Catheter-related bloodstream infections (CRBSIs) are a common complication in hemodialysis (HD) patients with central venous catheters (CVCs), and are often caused by Methicillin-Resistant Staphylococcus aureus (MRSA). Vancomycin is the preferred first-line treatment for MRSA-related CRBSI. At Hospital Pakar Sultanah Fatimah (HPSF), the current protocol for CRBSI in HD patients involves a weight-based intravenous (IV) vancomycin loading dose (LD) of 25 mg/kg, followed by therapeutic drug monitoring (TDM) within 48 hours post-administration. This study evaluates the adequacy of the initial dosing regimen in achieving the target serum vancomycin concentration (SVC) of 15–20 mcg/ml.
Methods: A retrospective cross-sectional study was conducted among hospitalized HD patients receiving IV vancomycin from July 1, 2022, to July 31, 2023. Data were collected from TDM request orders in the Pharmacy Information System (PhIS). The primary outcomes analyzed were the proportion of patients achieving the target SVC and factors influencing vancomycin pharmacokinetics. Multiple linear regression was used to assess associations between SVC and variables such as time-to-first-sampling (TTFS), age, and initial vancomycin dose.
Results: A total of 106 TDM samples were analyzed. The mean vancomycin LD was 1568.2 mg (SD 303.6), with a mean TTFS of 41.2 hours (SD 11.8). Only 32.1% of patients achieved the target SVC, while 56.6% had subtherapeutic levels and 11.3% had supratherapeutic levels. Multiple linear regression identified TTFS (p=0.003), age (p=0.002), and initial dose (p=0.004) as significant predictors of SVC.
Conclusion: The current vancomycin dosing protocol at HPSF does not consistently achieve therapeutic SVC in HD patients with CRBSI. Increasing the LD to 25–35 mg/kg and optimizing TTFS within 24–48 hours may improve target attainment. Further studies are needed to validate these findings and refine vancomycin dosing strategies in HD patients.
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Author Biography
Pei San Err, Pharmacy Department, Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
Head of Therapeutic Drug Monitoring Unit
