Treatment of paediatric vancomycin intoxication: a case report and review of the literature

Successful Utilization of High-Flux Hemodialysis for Treatment of Vancomycin Toxicity in a Child

“…Previous reports of vancomycin intoxication managed with high-efficiency dialysis membranes have reported vancomycin removal rates between 60 and 79 percent [11, 14]. Removal of vancomycin in our pediatric case was approximately 75 percent.…”

“…Standard membrane dialysis is largely ineffective and much slower in clearing higher mass molecules such as vancomycin (molecular weight approximately 1448 Daltons). Alternative methods to remove vancomycin from the intravascular space have included charcoal hemoperfusion (CH), gastric dialysis using multidose activated charcoal and exchange transfusion, with CH apparently the more efficient of the two [ 11 ]. While CH can remove approximately 40% of vancomycin from the intravascular compartment, this technique is accompanied by many adverse effects including hypocalcemia, hypothermia, hemodynamic compromise, and thrombocytopenia [ 12 ].…”

“…Our report highlights the safety and effectiveness of dialysis with an F40S hi flux polysulfone dialyzer to rapidly clear vancomycin from a pediatric patient in acute oliguric renal insufficiency. Previous reports of vancomycin intoxication managed with high-efficiency dialysis membranes have reported vancomycin removal rates between 60 and 79 percent [ 11 , 14 ]. Removal of vancomycin in our pediatric case was approximately 75 percent.…”

Antimicrobial Dosing in Acute Renal Replacement

“…For example, vancomycin toxicity is frequently reported at concentrations in tenfold excess of the therapeutic concentration (52, 53). Commonly encountered exceptions include aminoglycosides and amphotericin B which concentrate in the renal cortex, causing acute kidney injury.…”

Management of toxic ingestions with the use of renal replacement therapy

“…Historically, CH was the treatment for vancomycin intoxication as vancomycin was thought not to be well removed by RRT. More recently, the combination of high-flux HD and CRRT has been found to successfully decrease acute vancomycin levels [ 25 , 26 ]. It is possible to wait for the tissue levels to pass into the vascular space and upon rebound, repeat the HD procedure.…”