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As the NHS plunges further into the red, the search for innovative
cost-cutting measures increases.
On a very recent ward round, we were initially intrigued to notice
one of our patients with Clostridium difficile diarrhoea taking IV
vancomycin orally. At first we thought the IV infusion had been left on
the patients table by mishap. We duly asked the patient to stop and
informed the senior nurse.
To our utter bewilderment we were informed this was the desired
route. We explained this was an IV preparation being taken orally ?! The
ward pharmacist enlightened us with the rationale: this was cheaper than
Our concern was patient care, and whether the paradoxical
constitution and route of administration were causing harm -we checked the
BNF. A 28 pack of 125 mg tablets costs £66.23, whereas vancomycin power
for reconstitution as an infusion costs £8.05 for a 500 mg vial and £16.11
for a 1g vial, demonstrating a clear financial saving. Furthermore, a
small note at the bottom states the infusion powder 'can be used to
prepare solutions for oral administration'.