Purpose of review:Vancomycin is a first-line agent in the treatment of serious Gram-positive infections in the neonatal population. The published evidence on vancomycin toxicity in neonates is limited. This review summarises pre-clinical studies and clinical trials describing vancomycin toxicity. We discuss proposed pathophysiology and summarise evidence supporting dose-response relationships, genetic and environmental determinants, and consider future research required to further define vancomycin toxicity.
Recent findings:Current dosing regimens for vancomycin result in sub-therapeutic levels in a large proportion of patients. Higher daily doses have been proposed, which have led to concerns regarding increased toxicity. Nephrotoxicity occurs in 1-9% of neonates receiving currently recommended doses. The incidence is highest in those receiving concomitant nephrotoxic drugs. Vancomycin-associated ototoxicity is rare in patients of all ages. Exposure-toxicity relationships in relation to nephro-and ototoxicity have not been clearly defined in neonates receiving vancomycin.
Summary:Current evidence supports the favourable safety profile of vancomycin in neonates.Further studies that address safety concerns relating to high-dose intermittent dosing regimens are needed. Such studies must include robust and standardised definitions of renal and hearing impairment, and include follow-up of sufficient length to establish the long-term implications of experimental findings.
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