{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:15:05Z","timestamp":1775175305548,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T00:00:00Z","timestamp":1579651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Vancomycin dosing and monitoring recommendations are poorly adhered to in many institutions internationally, with concerns of treatment failure and propelling antibiotic resistance. The primary aim of this study was to audit the rate of adherence to American guidelines, with particular interest in loading dose administration. The secondary aims were (i) to determine whether or not guideline adherence results in therapeutic concentrations across body mass index (BMI) groups and (ii) to determine whether or not this was in turn associated with morbidity and hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Data were collected in a single tertiary hospital on all patients who had two or more serum vancomycin concentrations measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>In total, 107 patients met the inclusion criteria. Overall, 38.3% of patients were commenced on guideline adherent vancomycin doses, and 28.3% of overweight patients received an adherent first dose compared to 51.1% of non\u2010overweight people (difference 23%, 95% CI 4% to 41%, <jats:italic>P<\/jats:italic> = 0.024). Overweight patients were more frequently underdosed compared to non\u2010overweight patients (<jats:italic>P<\/jats:italic> = 0.039). The frequency and proportion of underdosing increased with BMI. Overweight patients spent a smaller fraction of their course within the therapeutic range, although the difference was not statistically significant (difference 7.7%; 95% CI 4% to 19.4%; <jats:italic>P<\/jats:italic> = 0.195). The overweight group had longer hospital length of stay (LOS), higher mortality and more treatment failures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adherence to guideline\u2010based prescription is poor, particularly in overweight patients. Patients who are initially underdosed have fewer therapeutic vancomycin days, regardless of BMI. Overweight patients have increased hospital LOS, hospital mortality and treatment failure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.14205","type":"journal-article","created":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T18:51:18Z","timestamp":1576867878000},"page":"958-965","source":"Crossref","is-referenced-by-count":7,"title":["Vancomycin: Audit of American guideline\u2010based intermittent dose administration with focus on overweight patients"],"prefix":"10.1111","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-8404","authenticated-orcid":false,"given":"Mari","family":"Koyanagi","sequence":"first","affiliation":[{"name":"John Hunter Hospital  Lookout Road New Lambton New South Wales 2305 Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Anning","sequence":"additional","affiliation":[{"name":"John Hunter Hospital  Lookout Road New Lambton New South Wales 2305 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Department of Health Australian Group on Antimicrobial Resistance AustralianStaphylococcus aureusSepsis Outcome Programme annual report (2014) Canberra http:\/\/www.health.gov.au\/internet\/main\/publishing.nsf\/content\/cda-cdi4002i.htm accessed August 15 2018"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-777X.68535"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080434"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1327"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002280050524"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.22.1.180-a"},{"key":"e_1_2_11_8_1","unstructured":"Australian Government: Australian Institute of Health and Welfare A picture of overweight and obesity in Australia (2017) https:\/\/www.aihw.gov.au\/reports\/overweight-obesity\/a-picture-of-overweight-and-obesity-in-australia\/contents\/table-of-contents Accessed September 2 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