Student Blog

Vancomycin is a glycopeptide antibiotic medication used to treat certain bacterial infections. It is administered intravenously to treat complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus (MRSA). vancomycin is approved by the FDA for intravenous and oral administration. The only approved indication for oral vancomycin therapy is in the treatment of pseudomembranous colitis, where it must be given orally to reach the site of infection in the colon.

The manufacturer recommended vancomycin dosage of 40 mg/kg/day in divided doses for children has not changed for decades despite increasing bacterial resistance over the past decade. An article by Benner et al. correlating vancomycin dosing to serum concentrations in pediatric patients concluded that vancomycin dosage regimens of 15 mg/kg every 6 to 8 hours produced peak and trough serum concentrations within their target range more frequently than 10 mg/kg every 6 to 8 hours.

According to Harriet Lane handook, the pediatric dose for vancomycin is 20 mg/kg per dose. At first glance, this might seem confusing, but the key distinction is that:

·The manufacturer's recommendation provides the total daily dose (40 mg/kg/day), while

·The Harriet Lane Handbook specifies per-dose recommendations (20 mg/kg/dose)

If vancomycin is given twice daily (Q12h) as per Harriet Lane, the total daily dose would match the manufacturer’s (40 mg/kg/day).

Thus, it is crucial to interpret dosing guidelines carefully to avoid confusion when determining the appropriate vancomycin regimen for pediatric patients.

- Nisha Jose, Pharm D Intern

A clinical intervention may be defined as “any professional activity by the pharmacist directed towards improving the quality use of medicines and resulting in a recommendation for a change in the patient’s medication therapy, means of administration or medication-taking behaviour”.

The Pharmaceutical Society of Australia has released comprehensive guidelines for pharmacists on performing clinical interventions to enhance medication safety and patient outcomes. These guidelines emphasize the importance of identifying, documenting, and addressing medication-related problems (MRPs) while maintaining professional judgment and compliance with relevant laws and standards.

By adhering to these guidelines, pharmacists can play a pivotal role in reducing medication errors, preventing adverse drug reactions, and improving health outcomes across community and aged care settings. 

- Abiral Sharma, Pharm D Intern

Lexicomp: 

• More efficient in terms of precise dosing, drug interactions, IV compatibility checks, Pk, adverse effects and contraindications

• Ideal for health care providers in clinical settings to make critical decisions.

Medscape:

• Provides references for drugs (though less detailed then Lexicomp).

• Provides broad overview of diseases and treatment guidelines.

• Provides updated medical news and CME opportunities.

Lexicomp (Lexi-Drug) is more reliable than Medscape for checking renal dosage adjustments, as it provides detailed references to support its recommendations. Additionally, Lexicomp offers a comprehensive database of drug-drug interactions, many of which are not available on Medscape, making it a more reliable resource for clinical decision-making. With its offline access feature for previously downloaded modules, Lexicomp ensures uninterrupted usability, even without an internet connection. In contrast, Medscape lacks consistency in assessing the severity of certain drug-drug interactions. For example, the interaction between ondansetron and fluconazole is categorized as "monitor closely" in Lexicomp but marked as “serious – use alternative” in Medscape. Such discrepancies reduce Medscape's reliability for forming strong clinical judgments on various aspects of drug use.

Using two platforms like Medscape and Lexicomp can lead to varying clinical judgments due to differences in their drug-related information. To ensure consistency and uniformity in clinical decision making, it is better to rely on a single platform, with Lexicomp standing out as the reliable choice due to its comprehensive and detailed resources.

-- Shreya Shastri and Nisha Jose

Interns at BBH