Epidemiology, appropriateness, and cost of vancomycin use.

Pharmaceutical costs, which approach $40 billion annually, account for about 8% of health care costs. Prescription drugs represent 5% to 20% of the total hospital budget, and antimicrobials account for 20% to 50% of hospital pharmaceutical costs. At one university hospital, the percentage of patients receiving antimicrobials increased from 31.8% in 1988 to 53.1% in 1994. Receipt of vancomycin has been associated with the emergence of resistant enterococci and has resulted in Centers for Disease Control and Prevention (CDC) recommendations for its use. Studies show that vancomycin use is increasing, that dosing is often inappropriate, that certain populations (such as oncology, neurosurgery, and cardiovascular surgery patients) are more likely to receive vancomycin, and that often use is not consistent with CDC recommendations. Few studies have assessed the cost of vancomycin use; those that have show that it is costly. Further studies of vancomycin use are needed, so that use can be improved through focused educational programs.