Risk of Nephrotoxicity with Combination Vancomycin‐Aminoglycoside Antibiotic Therapy

Study Objectives. To characterize patient sociodemographics and health, describe vancomycin treatment parameters and clinician‐rated outcomes, and determine costs associated with treatment including preparation and administration, adverse events, and toxicity.Design. A prospective study to develop a model for costs associated with antibiotic treatment (vancomycin).Setting. A community hospital.Patients. One hundred adults with active infections.Interventions. Mean duration of therapy was 10 days, and most patients received 2000 mg/day. Serum concentrations were monitored in two of three patients. Detailed cost analyses were completed on a subset of 26 patients selected at random from the overall sample.Measurements and Main Results. Sepsis and skin and skin structure infections were the most common indications for vancomycin therapy. Treatment was effective in 81 patients, failed in 9, and was not evaluable in 10. Thirty‐eight percent of patients experienced adverse events attributable to the drug. Phlebitis was common, and red man syndrome, nephrotoxicity, and ototoxicity were infrequent.Conclusions. Total cost of vancomycin treatment for 100 patients was $30,251: $23,855 for preparation and administration, $1710 for monitoring serum concentrations, and $4686 for treating adverse reactions. Drug costs accounted for only 55% of the total cost. Vancomycin is safe and effective, but phlebitis is underreported and significantly affects cost.

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Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Prabaker

Tran

Pratummas

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Vancomycin troughs of 15‐20 mg/L are recommended in the treatment of invasive staphylococcal disease, higher levels than previously recommended.OBJECTIVE/SETTING:We sought to determine if there was an association between vancomycin trough and nephrotoxicity, defined as 0.5 mg/L or 50% increase in serum creatinine, at a large Veterans Affairs medical center.PATIENTS AND METHODS:We reviewed records of 348 inpatients at our institution who received ≥5 days of vancomycin during 2 time periods when vancomycin dosing protocols differed (May 2005‐April 2006 and January 2007‐December 2007). Potential risk factors for nephrotoxicity were collected prior to nephrotoxicity onset, and all patients with nephrotoxicity events occurring within 5 days of starting vancomycin were excluded.RESULTS:Overall incidence of nephrotoxicity was 31/348 patients (8.9%). A similar percentage of patients experienced nephrotoxicity in 2005‐2006 versus 2007 (16/201 vs 15/147, respectively; P = 0.57), despite a rise in mean (9.7 mg/L in 2005‐2006 vs 13.2 mg/L in 2007; P < 0.0001) and highest (11.8 mg/L in 2005‐2006 vs 15.7 mg/L in 2007; P < 0.0001) vancomycin trough levels achieved. In a multivariate logistic regression model, only receipt of intravenous contrast dye was significantly associated with nephrotoxicity (OR 4.01, P < 0.001), though there was a trend toward an association between maximum vancomycin trough ≥15 mg/L and nephrotoxicity (OR 2.05, P = 0.082). Overall reversibility of nephrotoxicity either prior to or within 72 hours of vancomycin discontinuation was 77.8%.CONCLUSIONS:We conclude that nephrotoxicity, with higher trough levels occurring at ≥5 days of vancomycin therapy, was uncommon at our institution and typically reversible. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

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Risk of Nephrotoxicity with Combination Vancomycin‐Aminoglycoside Antibiotic Therapy

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Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

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