Perioperative Pharmacology: A Focus on Vancomycin

Hicks, Rodney W.; Hernandez, Johnanna

doi:10.1016/j.aorn.2010.09.031

Cited by 14 publications

(11 citation statements)

References 1 publication

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“…Nephrotoxicity was defined as increase in serum creatinine of 0.5 mg/dL or more or 50% of baseline for 2 consecutive days during the period from initiation of vancomycin therapy to 72 hours after completion of therapy. The specific adverse events we looked for were ototoxicity [17], hematologic [18][19][20][21], central nervous system [22,23], dermatologic [24][25][26][27] and cardiovascular [28,29].…”

Section: Inclusion Criteria and Outcomesmentioning

confidence: 99%

Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis

Steinmetz

Eliakim‐Raz

Goldberg

et al. 2015

Clinical Microbiology and Infection

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Recent Infectious Diseases Society of America guidelines for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections recommend maintaining vancomycin trough concentrations of 15-20 mg/L for serious infections. We conducted a systematic review and meta-analysis of all studies assessing the impact of low (<15 mg/L) vs. high (≥ 15 mg/L) vancomycin trough level on the efficacy of MRSA infections treatment. Four prospective and 12 retrospective studies were included (2003 participants). No significant difference was demonstrated between low and high vancomycin trough level for the outcome of all-cause mortality (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.78-1.46, I(2) = 28%). In studies evaluating mainly MRSA pneumonia, there was significantly higher mortality with low vancomycin level (OR 1.78, 95% CI 1.11-2.84). No significant difference was demonstrated in treatment failure rates (OR 1.25, 95% CI 0.88-1.78, I(2) = 51%). However, excluding one outlier study from the analysis, treatment failure became significantly higher in patients with low vancomycin trough level (OR 1.46, 95% CI 1.12-1.91, I(2) = 16%). Microbiologic failure rates were significantly higher in patients with low vancomycin levels (OR 1.56, 95% CI 1.08-2.26, I(2) = 0%). Nephrotoxicity was significantly higher with vancomycin levels of ≥ 15 mg/L. However, no cases of irreversible renal damage were reported. Current data on the effectiveness of higher vancomycin trough levels in the treatment of MRSA infections are limited to few prospective and mainly retrospective studies. Our findings support the current recommendations for maintaining vancomycin trough levels of ≥ 15 mg/L in the treatment of severe MRSA infections, although no difference in all-cause mortality was observed.

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Section: Inclusion Criteria and Outcomesmentioning

confidence: 99%

Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis

Steinmetz

Eliakim‐Raz

Goldberg

et al. 2015

Clinical Microbiology and Infection

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“…The syndrome usually involves symptoms of pruritus, flushing and an erythematous rash that involves the upper body and neck [74]. Hypotension, chest pain and muscle cramping have also been reported with this syndrome [75,76]. The symptoms usually occur within several minutes after infusing vancomycin, but delayed reactions can occur at the end of a 90–120 min infusion [70].…”

Section: Vancomycinmentioning

confidence: 99%

Nonallergic Drug Hypersensitivity Reactions

Farnam

Chang

Teuber

et al. 2012

Int Arch Allergy Immunol

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Background: Nonallergic drug hypersensitivities, also referred to as pseudoallergic or anaphylactoid reactions, have clinical manifestations that are often indistinguishable from allergic reactions. Methods: We performed a PubMed search using the terms ‘drug allergy, drug hypersensitivity, pseudoallergies, anaphylaxis and nonallergic drug reactions’ and reviewed 511 publications dated between 1970 and 2012. A total of 160 papers that were relevant to the most common nonallergic drug hypersensitivity reactions were selected for discussion. Results: Nonallergic drug hypersensitivities do not involve either IgE-mediated (type 1) or delayed (type 4) hypersensitivity. Nonallergic hypersensitivities are commonly referred to as pseudoallergic or idiosyncratic reactions. The common nonallergic drug hypersensitivities are secondary to chemotherapeutic drugs, radiocontrast agents, vancomycin, nonsteroidal anti-inflammatory agents, local anesthetic reactions and opiates. Protocols for skin testing of radiocontrast, nonsteroidal anti-inflammatory agents, local anesthetics and chemotherapeutic agents have been developed, though most have not been validated or standardized. Other diagnostic tests include in vitro-specific IgE tests, and the current ‘gold’ standard is usually an oral challenge or bronchoprovocation test. In the case of aspirin, even though it is not believed to be IgE-mediated, a ‘desensitization’ protocol has been developed and utilized successfully, although the mechanism of this desensitization is unclear. Conclusions: Diagnostic methods exist to distinguish allergic from nonallergic drug hypersensitivity reactions. The best option in nonallergic drug hypersensitivity is avoidance. If that is not possible, premedication protocols have been developed, although the success of premedication varies amongst drugs and patients.

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“…It is supplied as sterile powder, and directions recommend a dilution of 2.5 to 5.0 mg/mL (ANVISA internet site 2013, Jelassie et al 2011). The drug has to be slowly infused during a period of at least 60 minutes with injection site rotation (Jelassie et al 2011, Hicks andHernandez 2011).…”

Section: Introductionmentioning

confidence: 99%

Endothelial, renal and hepatic variables in wistar rats treated with Vancomycin

Bruniera

Ferreira

Savioli

et al. 2014

An. Acad. Bras. Ciênc.

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Vancomycin (VCM) is indicated in combat against Gram-positive infections, but it is not considered a first-choice drug because of its adverse effects. It is believed that oxidative stress is the primary mechanism of endothelial injury and the consequent VCM toxicity, which varies from phlebitis to nephrotoxicity. Moreover, dose recommendations, dilution, rates and types of infusion are still controversial. The aim of this study was to determine the effect of different VCM dilutions in endothelial, liver and kidney injuries by biochemical parameters and histopathological analysis. Wistar rats were randomly divided into six groups and subjected to femoral vein cannulation for drug administration. Control groups received 0.9 ml of saline and the others received VCM (10mg/Kg/day) at dilutions of 5.0 and 10.0 mg/mL for 3 and 7 days. Homocysteine, hs-CRP, AST, ALT, GGT, urea, creatinine, lycopene, alpha-tocopherol, beta-carotene and retinol were analyzed. Kidney, liver and cannulated femoral vein fragments were collected.This study showed alterations in ALT which featured hepatotoxicity. However, drug dilutions were not able to show changes in other biochemical parameters. In contrast, kidney and endothelium pathological changes were observed. More studies are needed to characterize VCM induced kidney and endothelium toxicity and biochemical markers able to show such morphological modifications.

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Perioperative Pharmacology: A Focus on Vancomycin

Cited by 14 publications

References 1 publication

Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis

Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis

Nonallergic Drug Hypersensitivity Reactions

Endothelial, renal and hepatic variables in wistar rats treated with Vancomycin

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