Purpose: The prescription of glycopeptides (GP) was evaluated in hospitalized patients.
Methods: A 1-day survey was performed in 10 hospitals of the Île-de-France region regarding the prescription of GP. Characteristics of the included patients, indications of prescription and modalities of GP administration were studied independently of the prescribers.
Results: Overall, 90 patients (median age of 49 years [10 days-89 years]) were treated with a GP (vancomycin: 76; teicoplanin: 14). Indications of therapy included a microbiologically documented infection in 40 cases (44%), an empiric therapy in 44 cases (49%) and a prophylaxis in six cases (7%). In documented infections, main isolated pathogens were: coagulase-negative staphylococci (49%) and Staphylococcus aureus (32%) that were susceptible to methicilline in 27 and 26%, respectively. Vancomycin was administered intravenously (IV) in 71 cases (intermittent dosing in 41 patients (58%) and continuous infusion in 30 patients (42%), as central venous catheter lock in four patients and per os in one patient. In continuously infusion regimens, a loading dose at the initiation of treatment had been administered in 19 cases (63%). The median dosage the first day of curative treatment was <20mg/kg in 10 patients (20% of patients had normal renal function). Teicoplanin (median dosage: 8mg/kg, [3-13]) was IV infused in 86% of cases. Monitoring of serum GP concentrations was performed in only 58% of the cases (vancomycin: 47; teicoplanin: five). A low trough serum concentration was observed in 54% of the 52 monitored patients. The dosage of GP was readapted in only 55% of such cases.
Conclusion: In this 1-day survey, we observed that GP administration was not optimal. Indeed, prolonged prescription of GP as empiric therapy was frequent, monitoring was not systematic, and prescribed dosages were often inadequate.
Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.