Extremely high levels of vancomycin can cause severe renal toxicity

Abstract

Vancomycin has usually been associated with nephrotoxicity. Generally, this toxicity is presented as proximal tubular cells injury with or without necrosis and as acute interstitial nephritis. However, development of both lesions is uncommonly described in literature. We present a case of vancomycin-induced nephrotoxicity resulting in both acute interstitial nephritis and tubular cells damage confirmed by renal biopsy. Peak and trough levels of 77.11 and 63.60 μg/mL, respectively, were obtained at the first plasma determination. After 8 more plasma determinations and several hemodialysis sessions, vancomycin levels were undetectable 1 month after therapy was stopped. To our knowledge, this is the case report with the highest vancomycin trough levels developing both lesions and describing total vancomycin washout after a biopsy-proven vancomycin toxicity. In conclusion, early vancomycin therapeutic drug monitoring should be performed in order to avoid toxicities where, as seen in our patient, antibiotic exposure could last around 1 month after last dose administration.

Vancomycin trough level and loading dose

“…We read with interest the paper by Barceló-Vidal et al 1 about vancomycin nephrotoxicity due to high trough levels with histopathology. The authors described a case developing both lesions and described total vancomycin washout after a biopsy-proven vanco-mycin toxicity.…”

“…After reading the paper by Barceló-Vidal et al, 1 we also performed an analysis of patients with vancomycin trough level of >60 mg/L. From 164 patients, six had vancomycin trough level of >60 mg/L, and 50% (3/6) had severe AKI (AKIN 3): OR=5.38 (95% CI: 1.02–27.87; P <0.05).…”

Antimicrobial peptides-An alternative candidates to antibiotics against Staphylococcus aureus and its antibiotic-resistant strains

“…However, vancomycin can cause severe renal toxicity when used at extremely high concentrations. The toxicity also depends on the length of the treatments [157,158]. Therefore, the infection by these resistant strains is becoming more difficult to treat.…”

Model-Informed Precision Dosing of Antibiotics in Pediatric Patients: A Narrative Review

“…These populations can greatly benefit from individualized dosing. Dosing in pediatric patients, especially antibiotic and anticancer drug treatment, is challenging and can result in supratherapeutic exposure that potentiates undesirable side effects or toxicity ( 16 – 18 ), while subtherapeutic exposure can contribute to treatment failure ( 19 , 20 ). Moreover, under-exposure of antibiotics may result in further emergence of drug resistance, although this relationship has not been studied in detail.…”