Mild Nephrotoxicity Associated With Vancomycin Use

Downs, Nancy J.; Neihart, Robert E.; Dolezal, Jeanette M.; Hodges, Glenn R.

doi:10.1001/archinte.1989.00390080053013

Cited by 88 publications

(24 citation statements)

References 6 publications

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“…7,[16][17][18] Similar results have been confirmed in the present study. That is, an increase in the baseline SCr concentration above 0.3 mg/dl occurred in 26 of 184 patients (14.1%): 6 of 73 (8.2%) and 20 of 111 patients (18.0%) in the TDM group and the non-TDM group, respectively ( Table 1).…”

Section: Discussionsupporting

confidence: 93%

Clinical Efficacy of Therapeutic Drug Monitoring in Patients Receiving Vancomycin

Iwamoto

Kagawa

Kojima

2003

Biological & Pharmaceutical Bulletin

102

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Vancomycin (VCM), a glycopeptide antibiotic, was developed and released in the 1950's for the treatment of aerobic gram-positive infections and has been widely used mainly in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. Early reports regarding the possibility of nephrotoxicity and ototoxicity led to concern about the use of VCM and monitor serum VCM concentrations.In general, the purposes of therapeutic drug monitoring (TDM) are to improve clinical effects, to avoid side effects, and to reduce drug costs. In the case of VCM, however, an exhaustive review of the literature revealed that there are no studies analyzing a direct effect of serum VCM concentrations and clinical outcome.1-3) There have been a few studies examining the minimum inhibitory concentration (MIC)/ minimum bactericidal concentration (MBC) ratios and cure rates, 4-6) these studies are not efficient to answer the question what concentration of VCM was required for the successful treatment of infections. Recently, some clinical reports evaluating the TDM of VCM have proposed the following conclusions: 1) TDM is associated with a decreased incidence of VCM-induced nephrotoxicity, indicating that TDM is a cost-effective procedure, 1,[7][8][9] and 2) VCM works most effectively if the concentration at the site of infection is maintained above MIC values throughout the dose interval. So, the clinical efficacy of VCM can usually be obtained if the trough concentration is sufficiently above the MIC at the site of infected organisms. 10,11) Since the MIC values for susceptible organisms were below 5 mg/ml and reported toxicities had occurred most often at drug serum concentrations above 40 mg/ml, clinicians and researchers designated therapeutic trough concentrations at 5-15 mg/ml and peak concentrations at 25-40 mg/ml. 1,[12][13][14] In practice, however, the peak concentration hardly exceeds 40 mg/ml, as long as the trough concentration is kept below 15 mg/ml. 15) For this reason, the policy of monitoring the trough concentration alone for VCM has recently spread worldwide. In Japan, however, both the trough and peak concentrations of VCM are monitored in most of hospitals. Therefore, it would be worthwhile to investigate whether monitoring peak concentration is essential or not.The purpose of the present study was to investigate the clinical utility of the TDM VCM and the relationship between its peak concentrations and clinical effects in MRSAinfected patients. MATERIALS AND METHODS Subjects and Study DesignSubjects (0-86 years of age) in this retrospective study were MRSA-infected patients who received intravenous infusion of VCM (Shionogi & Co., Ltd., Osaka, Japan) from January 1996 to March 2002 and also had confirmed the disappearance of the bacteria thereafter.The incidence of nephrotoxicity, including VCM-induced or MRSA-related nephrotoxicity, was compared between the TDM group (nϭ73) and the non-TDM group (nϭ111). Serum VCM concentrations in the TDM group were monitored within 10 d from the start of VCM ther...

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Section: Discussionsupporting

confidence: 93%

Clinical Efficacy of Therapeutic Drug Monitoring in Patients Receiving Vancomycin

Iwamoto

Kagawa

Kojima

2003

Biological & Pharmaceutical Bulletin

102

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“…Furthermore, after adjusting for APACHE II scores, no difference was apparent in the nephrotoxicity incidence in the two groups. Our results are supported by previous studies that failed to find an association between comorbidity, concomitant treatment with purported nephrotoxic agents, and vancomycin-induced nephrotoxicity [23,37].…”

Section: Discussionsupporting

confidence: 91%

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies

Efird

Guidry

et al. 2015

Surgical Infections

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“…The incidence of vancomycin-induced nephrotoxicity is variable and ranges from 12 to 42% in various studies [26,27]. The variability in the reported range is due to variations in the populations selected for study, under-reporting of nephrotoxicity and different dosing regimens employed in each of these studies [28,29,30,31,32,33,34,35,36], as summarized in table 2.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Vancomycin Nephrotoxicity in Elderly Chinese Patients

et al. 2015

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This study explored nephrotoxicity in elderly Chinese patients after exposure to vancomycin and other nephrotoxic risk factors. This was a single-center retrospective study. The patient population included those who were ≥60 years of age, had normal baseline serum creatinine values, and received vancomycin for ≥48 h between January 1, 2013 and August 30, 2014. Nephrotoxicity occurred in 29% of 124 patients. A baseline creatinine clearance ≥63.5 ml/min was more common in the nephrotoxic group. Patients with high (≥15 mg/l) rather than low (<15 mg/l) average vancomycin troughs had elevated nephrotoxicity (47.2 vs. 27.3%, p = 0.0001). Of the comorbid conditions evaluated, there were more patients with shock (p = 0.001), hypertension (p = 0.020) and congestive heart failure (p = 0.04) in the nephrotoxic group. Drugs frequently given at the same time with vancomycin, such as angiotensin receptor blockers and furosemide, were also associated with increased nephrotoxic risk. In conclusion, nephrotoxicity was frequently observed in patients with concurrent vancomycin trough concentrations ≥15 μg/ml and hypertension, shock, congestive heart failure. In addition, drugs concurrently used with vancomycin may also increase its nephrotoxicity. Therefore, renal function and vancomycin serum troughs should be closely monitored, especially in patients with other renal injury risk factors.

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Mild Nephrotoxicity Associated With Vancomycin Use

Cited by 88 publications

References 6 publications

Clinical Efficacy of Therapeutic Drug Monitoring in Patients Receiving Vancomycin

Clinical Efficacy of Therapeutic Drug Monitoring in Patients Receiving Vancomycin

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Retrospective Analysis of Vancomycin Nephrotoxicity in Elderly Chinese Patients

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