Large Vancomycin Overdose in Two Premature Infants with Minimal Toxicity

Miner, Lonnie J.; Faix, Roger G.

doi:10.1055/s-2004-835959

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…A high serum vancomycin concentration is associated with transient nephrotoxicity. 9,10,16,23 Indeed, nephrotoxicity was observed in all of our patients. However, even in pediatric patients requiring hemodialysis due to a vancomycin overdose, the renal function recovered completely.…”

Section: Discussionsupporting

confidence: 50%

“…Although the patients were exposed to extremely high serum concentrations of vancomycin with the estimated peak serum concentration ranging from 161 to 659 mg/L, they did not experience prolonged auditory impairment. In previous studies of preterm infants, no patient developed either transient or prolonged auditory impairment despite achieving a vancomycin serum concentration of 305 to 427 mg/L 9,10,16 (Table 4) even though preterm neonates generally tend to develop hearing problems more often than term neonates. 17 In an animal study, guinea pigs were challenged for 11 to 17 days with vancomycin 200 mg/kg/day without showing any changes in the cochlear hair cell count or auditory brainstem response.…”

Section: Discussionmentioning

confidence: 86%

“…8 Cases of accidental vancomycin overdose resulting in a high serum vancomycin concentration have been reported in pediatrics, but the effects of overdosing, specifically ototoxicity, are still unclear. 9,10 The purpose of our study was to examine the incidence and severity of ototoxicity in pediatric patients with a high serum vancomycin concentration.…”

Section: Introductionmentioning

confidence: 99%

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Ototoxicity and Nephrotoxicity With Elevated Serum Concentrations Following Vancomycin Overdose: A Retrospective Case Series

Uda¹,

Suwa²,

Ito³

et al. 2019

The Journal of Pediatric Pharmacology and Therapeutics

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Although a high vancomycin serum concentration is known to be associated with nephrotoxicity, its association with ototoxicity is not well known. The purpose of our study was to examine the latter association in pediatric patients, especially in cases of accidental overdose. Pediatric patients who received vancomycin at our facility between March 2010 and December 2015 with a serum trough concentration > 30 mg/L were enrolled. Age, sex, neonatal hearing screening results, estimated peak vancomycin serum concentration, duration of drug exposure, renal function, and hearing test results were collected. The estimated duration of concentrations above 30 or 80 mg/L were simulated with the Sawchuk-Zaske method. We defined a “high concentration” and “toxic concentration” of vancomycin as 30 to 80 mg/L and > 80 mg/L, respectively. Ototoxicity was assessed based on the auditory brain stem response. We identified 4 females and 2 males with normal hearing at birth. Four of the 6 patients were ≤ 3 months old. All the patients reached an estimated peak serum concentration of > 80 mg/L, and 5 exceeded 150 mg/L. The estimated duration of exposure to a high concentration and toxic concentration of vancomycin was 15 to 62 hours and 8 to 43 hours, respectively. All the patients experienced transient renal dysfunction. Although transient ototoxicity was found in 1 patient, prolonged ototoxicity was not observed in any of the patients. All the patients had received an accidental overdose of vancomycin. Prolonged hearing loss due to a high vancomycin serum concentration was not found in any of the subjects in the present report.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Ototoxicity and Nephrotoxicity With Elevated Serum Concentrations Following Vancomycin Overdose: A Retrospective Case Series

Uda¹,

Suwa²,

Ito³

et al. 2019

The Journal of Pediatric Pharmacology and Therapeutics

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“…In the paediatric population, the reported adverse effects of vancomycin include neutropenia, fever, phlebitis, nephrotoxicity, ototoxicity, thrombocytopenia, skin disorders and the ‘red man syndrome’ . Some studies reported that the risk may well exceed 60% whereas others concluded that the risk was low, even for overdoses of vancomycin .…”

Section: Discussionmentioning

confidence: 99%

Duration of vancomycin treatment for coagulase‐negative Staphylococcus sepsis in very low birth weight infants

Linder

Lubin

Hernandez

et al. 2013

Brit J Clinical Pharma

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AIMVancomycin is widely used to treat late onset coagulase-negative Staphylococcus (CoNS) sepsis in very low birth weight (VLBW) infants. Although vancomycin is associated with a risk of toxicity and bacterial resistance, the appropriate duration of use has not been established. This study sought to investigate the association between the duration of vancomycin therapy and clinical outcome in VLBW infants with CoNS sepsis. METHODSThe files of all VLBW infants treated for CoNS sepsis at a tertiary paediatric medical centre from 1995-2003 were reviewed for clinical data, laboratory variables and outcome. Only patients with two positive diagnostic blood cultures were included. The findings were analyzed by duration of vancomycin treatment after the last positive blood culture. RESULTSThe study cohort included 126 infants, 48 treated for 5 days, 32 for 6-7 days, 31 for 8-10 days and 15 for >10 days. There were no differences among the groups in perinatal characteristics, central catheter dwell time, laboratory data including haematologic, renal and liver function tests, or rate of complications of prematurity. Five infants were diagnosed with infective endocarditis or aortic thrombi and were treated for >10 days. CoNS sepsis recurred in two infants (1.6%). No toxicity of vancomycin treatment was observed.

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“…11,12 We acknowledge that the mechanism of vancomycin nephrotoxicity is more uncertain than that of many other nephrotoxic drugs, although risk factors have been identified from studies in adults. Trough concentrations of 15–20 mg/L during intermittent vancomycin dosing in adults are associated with a modest increase in nephrotoxicity.…”

mentioning

confidence: 99%