# Effect of introducing a pharmacist-led support system on the administration rate of vancomycin loading dose and the 0–24-hour area under the concentration–time curve

## TL;DR

A pharmacist-led support system improved vancomycin dosing in hospitalized patients, leading to better drug effectiveness without increasing kidney injury or mortality.

## Contribution

Demonstrates the effectiveness of pharmacist-led interventions in optimizing vancomycin loading doses in clinical practice.

## Key findings

- The loading dose administration rate increased by 43.2% after implementing the pharmacist-led system.
- AUC0–24 improved significantly, indicating better drug exposure without increased acute kidney injury or mortality.
- The positive effects were immediate and sustained over 122 weeks.

## Abstract

This study aimed to evaluate the impact of a pharmacist-led support system on the administration rate of vancomycin (VCM) loading dose, 0–24-hour area under the concentration–time curve (AUC0–24), incidence of acute kidney injury (AKI), and all-cause mortality in hospitalized patients.

This retrospective study with interrupted time series analysis was conducted from January 2021 to May 2024.

A public tertiary referral center providing acute and specialized inpatient care in Japan.

Among the 587 hospitalized patients who received VCM during the study period, 326 were evaluated.

The intervention comprised implementation of a pharmacist-led support system involving prospective prescription review and direct intervention when a VCM loading dose (25–30 mg/kg) was not prescribed.

The loading dose administration rate increased significantly by 43.2% immediately introducing the support system (95% confidence interval: 8.40–77.90; P = 0.0156), without significant trend change thereafter. AUC0–24 also increased significantly (241.0 vs 307.0; P < 0.001); there were no significant differences in AKI incidence or 90-day mortality.

The support system improved the loading dose administration rate and AUC0–24 without significantly increasing AKI or mortality. The improvement was immediate and sustained over 122 weeks, supporting its use in institutions aiming to optimize VCM loading doses where evidence remains limited.