Impact of ascorbic acid in reducing the incidence of vancomycin associated nephrotoxicity in critically ill patients: A preliminary randomized controlled trial

Abstract

Background Antioxidants show nephroprotective effect against vancomycin associated nephrotoxicity (VAN) in animals. This study aimed to assess the ascorbic acid nephro-protective role against VAN clinically. Methods Forty-one critically ill patients were randomly assigned to one of two groups: intervention group (vancomycin IV plus ascorbic acid, n=21) or control group (vancomycin IV only, n=20). Primary outcomes were the incidence of VAN and the absolute change in creatinine parameters, while mortality rate was the secondary outcome. Nephrotoxicity was defined as an increase in serum creatinine (S.cr) by at least 0.5 mg/dL or 50% of baseline for at least two successive measurements. This study is registered at Clinicaltrials.gov (NCT03921099), April 2019. Results Mean absolute S.cr increase was significant when compared between both groups, P-value = 0.036, where S.cr increased by 0.05(0.12) and 0.34(0.55) mg/dL in the intervention and control groups, respectively. Mean absolute Cr.cl decline was significant when compared between both groups, P-value = 0.04, where Cr.cl was decreased by 5.9(17.8) and 22.3(30.4) ml/min in the intervention and control groups, respectively. Incidence of VAN was 1/21(4.7%) versus 5/20(25%) in the intervention and control groups, respectively (RR: 0.19; CI: 0.024–1.49; P-value = 0.093). Mortality was higher in the control group; however, it was not statistically significant, P-value = 0.141. Conclusion Co-administration of ascorbic acid with vancomycin preserved renal function and reduced the absolute risk of VAN by 20.3%, however, the reduction in VAN incidence didn’t reach statistical significance level. Further large multicenter prospective trials are recommended.

The effects of vitamin C supplementation in the critically ill patients outcomes: A systematic review and meta-analysis of randomized controlled trials

“…And data on pneumonia were reported in 2 studies. [19,27] Compared with the placebo, the administration of IVVC had no statistical difference (RR 0.85; CI 0.50–1.44; I 2 = 0%, P = .552) (Fig. 3J).…”

“…We included 5 studies [ 18 , 19 , 22 , 27 , 29 ] about fluid intake. Compared with the placebo, the administration of IVVC had no statistical difference (SMD −0.02; CI −0.25 to 0.20; I 2 = 0%, P = .838) (Fig.…”

“…After the remaining 103 pieces of literature were searched for full text, reading, and quality assessment, 19 pieces of literature [10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (2047 patients: vitamin C: 1018 vs placebo: 1029) were eventually included (Figure 2: guidelines flow diagram). The detailed information on this literature is listed in Table 1.…”

“…Data on 28-d mortality were reported in 10 studies. [10,[18][19][20][21]24,26,[28][29][30] Compared with the placebo, the administration of IVVC had no statistical difference (RR 0.90; CI 0.77-1.04; I 2 = 9.8%, P = .139) (Fig. 3B) and we included 4 studies about mortality.…”

Synergistic antimicrobial effect of ascorbic acid and nicotinamide with rifampicin and vancomycin against SCCmec type IV methicillin-resistant Staphylococcus aureus (MRSA)

“…In clinical settings, vitamin C vaginal suppositories showed comparable efficacy to metronidazole against bacterial vaginosis (BV); in fact, another paper recorded a better prognosis for BV when co-administering vitamin C and metronidazole [21,22]. Additionally, co-administration of ascorbic acid with vancomycin has been associated with preserved renal function and reduced vancomycin-associated nephrotoxicity in animal models and critically ill patients [23,24].…”