Impact of pharmacist intervention in preventing nephrotoxicity from vancomycin

Objectives: To evaluate the impact of pharmacist interventions on preventing nephrotoxicity from vancomycin. Methods: A pre- to postpharmacist intervention study was performed in the Tsuyama Central Hospital. 508 Patients admitted from May 2007 to May 2012 served as the non-pharmacist intervention group, while 102 patients admitted from June 2012 to November 2013 formed the pharmacist intervention group. Pharmacist interventions were mainly performed for the initial dosage planning, controlling vancomycin prescriptions, and real-time monitoring of medical records before routine therapeutic drug monitoring. The non- and pharmacist intervention groups were compared to evaluate the outcomes of pharmacist interventions. Results: By pharmacist interventions, initial trough concentration of vancomycin promptly tightened within the 10 - 20 mu g/mL therapeutic trough concentration range (p < 0.001), and reaching an ineffective or risky trough concentration was avoided. Also, the mean vancomycin trough concentrations of patients with and without nephrotoxicity were 23.9 and 13.9 mu g/mL, respectively. Furthermore, by multivariate logistic regression analysis, significant increased risks of nephrotoxicity in baseline creatinine clearance, and 15 - 20 and over 20 mu g/mL of initial vancomycin trough concentration were observed. Significant decreased risk of nephrotoxicity was gender (male). Although pharmacist intervention showed a trend of 45% decrease in the incidence of nephrotoxicity, there was no significant difference between the pharmacist intervention and non-intervention groups. Conclusion: Pharmacist intervention may have an impact on vancomycin therapy from the standpoint of balancing a higher vancomycin trough concentration with risk of nephrotoxicity.