IV Vancomycin given orally 2 save $$$

[Kelly_the_Great]

Have any of you heard of given IV prepared Vancomycin to patients orally in order to save money? Could be for them or hospital.

Any ways we have a doctor you recommended and now we're trying to find some info on it. So far all I found is a Johs Hopkins article stating it (w/o notable reference) and info on the Angry Pharmacist.

Please let me know if any of you perform this at your hospital or if you recommend to the patient to use it following discharge.

Thanks,

[Agnus]

I have on rare occasion given oral vanco. This was not IV prepared. I believe but can't be sure the oral was possible a lower dose and possibly a maintainence dose.

I can not imagine giving an med orally that was prepared for IV.

I can not see how giving it by an oral route once prepared for IV would save money.

Saving money is not criteria for giving Vanco. An antibiotic not given in the correct dosage and route looses its effectiveness. That would infact increase cost. Over the long haul. And would cause the bug to become Vanco resistant.

This does not make sense to me.

Yes, vanco is given orally. When it is given orally it is not prepared for IV. Yes it is a legitimate use of vanco in certain situations.

[Agnus]

I have seen this in every hospital I have ever worked in. MOST of the time it is IV but there are those execptions.

[cardiacRN2006, ADN, RN]

We've given all kinds of PO vanco and it's the preferable route in most cases as the med can get absorbed directly into the GI tract. IV vanco can't penetrate the GI tract like PO can. This can save money by decreasing LOS D/T decreasing infection.

As far as IV prepared vanco used orally? I don't understand? Are you talking about the IV liquid preparation or the powder that is reconstituted?

[NurseyBaby'05, BSN, RN]

We give it PO to pt's with hard to resolve c-diff. It seems to work better if it actually goes through the GI tract.

As for saving money, I doubt it. One pt had to go home on the PO and his co-pay (not the whole cost of the medicine) for six weeks worth was over $1900 dollars. It was actually cheaper to send him home on IV with home care, but it wasn't effective for him.

[rph3664]

Vancomycin capsules are extremely expensive. IV vancomycin is not.

What I think everyone is trying to say is that the IV formulation is being reconstituted and given orally. I've seen that done, and yes, it's much less expensive and probably just as effective for C. difficile, although I have no idea what it might taste like.

[ohmeowzer RN, RN]

i thought po vancomycin only worked on c-diff and no other infections.... are you sure the pt isn't being treated for c-diff?

[Kelly_the_Great]

Thanks to everyone who has replied! :)

The vancocin given orally in this instance is to treat c-diff. Like NurseyBaby05 mentioned in some cases it works better if it goes through the gut for c-diff. Particularly, since vanc has bioavailability with it's absorption through po route ~ meaning it only stays in the gut, it's not distributed systemically. That's why it's not very effective for other infections, i.e. staph, etc. when given oral vs. parental.

Anyways, as far as cost, you're looking at IV vancomycin at apprx $4 vs. $128 per day for the pill. So, in regards to compliance (I mean how can pts be compliant in taking the entire dose regimen when they can't even afford it???) price is important. It seems crazy to me, but the IV preparation is actually considerably cheaper ~ go figure.

Several ppl posted on the Angry Pharmacist blog that they use it but there are no references! John Hopkins just posted an article yesterday that you could use it in that fashion as well but, again, no references!

If anybody knows of any, please let me know. If you're pharmacy is practicing this method, please ask them if they have any references. Saving patients money is important (if & only if it's just as effective ~ btw agnus, you're reaction was my initial reaction too...lol ~~ sounds bizarre, I know giving IV prepared orally ). Plus, if it's just as good, if the word could be disseminated, perhaps it would put pressure on the drug company to lower the cost of the po product where normal folks could afford it.

Maybe we wouldn't be seeing the VRE if more ppl could afford to take their full dose of vanc, you know?

Again, thanks for everyone's input!

[leslie :-D]

from John Hopkins...

http://www.hopkins-hivguide.org/drug/antimicrobial_agents/vancomycin.html

scroll down to USUAL ADULT DOSING

"IV vancomycin can be given orally for C. Difficile colitis to decrease cost ($4 vs. $128 per day).

kelly, to me, this would be the reference you seek.

leslie

[Kelly_the_Great]

I don't think it'll suffice as far as EBP criteria goes. I mean, I think they'll want like an RCT or something.

I'm in favor of EBP; however, sometimes, I think it slows things down, you know? Particularly, if you have corporations driving the market. Since most of the drug companies are the ones doing the testing, etc. they're not going to want to publish anything that would lose them money, right?...:stone

[morte, LPN, LVN]

the first time i saw this was 18-20 years ago....what do you need for EBP (which to me is another way of avoiding change)....it would seem since you are dealing with the same drug, that safety would be the issue and i would think the company that produces it would have brought any saftey issues to the fore......as a reason to promote that exp. po prep....which by the way, is solid inside the cap,,,, try giving it thru a g tube

[cardiacRN2006, ADN, RN]

Wow, the Vanco po that I've given has been either a liquid or a tab. Never a capsule.