Intravenous vancomycin usage in a tertiary care hospital.

Intravenous vancomycin usage at our institution was examined by a five-month retrospective chart review. Cardiovascular surgery, neurosurgery, and intensive care units accounted for the most use. Sixty courses in 48 patients were reviewed; 42 percent was considered inappropriate, which extrapolated to an annual drug acquisition cost of $51,338. Inappropriate use was categorized as mainly due to documented infection with a beta-lactam sensitive organism in a patient with no history of an allergy (40 percent of inappropriate use) and excessive duration of empiric therapy (28 percent of inappropriate use). Concurrent monitoring by pharmacy staff was felt to be the approach most likely to be effective in modifying this problem.