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Vancomycin nephrotoxicity

Kristen A O'Brien, Steve Mok
BACKGROUND: Dosing vancomycin to achieve target concentrations of 15 to 20 mg/L has been recommended for select infections. To date, few vancomycin nomograms designed to target these higher concentrations have been published, and only one has been published in North America. Based on the success of this nomogram in developing empiric vancomycin regimens that achieve higher target trough concentrations with low rates of nephrotoxicity, a vancomycin nomogram targeting concentrations of 15 to 20 mg/L was developed and implemented at Emory University Hospital and Emory University Hospital Midtown...
November 2015: Hospital Pharmacy
Junlan Chuan, Yuan Zhang, Xia He, Yuxuan Zhu, Lei Zhong, Dongke Yu, Hongtao Xiao
Objective: Telavancin is approved to treat complicated skin and skin structure infections, hospital-acquired, and ventilator-associated bacterial pneumonia caused by Staphylococcus aureus. A previous meta-analysis of randomized controlled trials suggested that it might be an alternative to vancomycin in cases of difficult-to-treat meticillin-resistant S. aureus infections. We did a meta-analysis including one new trial to access the efficacy and safety of telavancin. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, EMBASE and ClinicalTrials...
2016: Frontiers in Pharmacology
Katherine E McQueen, Dana W Clark
OBJECTIVES: To determine if the incidence of nephrotoxicity is higher in pediatric patients treated with the combination of vancomycin and piperacillin-tazobactam, compared to patients treated with vancomycin alone. Secondary objectives were to determine if admission to an intensive care unit (ICU), higher serum vancomycin trough concentrations (>15 mg/L), or receipt of other nephrotoxic agents were related to the development of nephrotoxicity. METHODS: This was a retrospective, single-center, cohort study of 79 patients treated with vancomycin and 106 patients treated with vancomycin and pipracillin/tazobacatam (TZP)...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Shagufta Vora
Vancomycin-induced nephrotoxicity is a commonly feared and largely preventable adverse effect of vancomycin therapy. We present the case of a 56-year-old woman who developed acute renal failure requiring hemodialysis as a result of unmonitored vancomycin infusions for the treatment of osteomyelitis.
October 2016: Proceedings of the Baylor University Medical Center
Sasima Tongsai, Pornpan Koomanachai
BACKGROUND: Recent guidelines have recommended vancomycin trough levels of 15-20 mg/L for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, high trough levels may increase risk of nephrotoxicity and mortality, and high vancomycin trough levels have not been well studied. This study was designed to combine safety and efficacy results from independent studies and to compare between high and low vancomycin trough levels in the treatment of MRSA-infected patients using meta-analysis...
September 29, 2016: BMC Research Notes
Andrew P Smith, Catherine A Millares-Sipin, Marian James, Henry Cohen
OBJECTIVES: Evaluate the clinical impact of pharmacist-initiated vancomycin monitoring and dosing in a long-term care setting. DESIGN: Single-center, pretest, post-test design. SETTING: Rutland Nursing Home, Brooklyn, New York. PARTICIPANTS: Nursing facility residents treated with intravenous vancomycin (N = 198). OUTCOME MEASURES: The primary objective is to determine the incidence of acute kidney injury (AKI) a year before and a year after implementation of a pharmacist-initiated vancomycin-monitoring protocol...
September 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
W-X Wei, X-L Qin, D-H Cheng, H Lu, T-T Liu
WHAT IS KNOWN AND OBJECTIVE: Vancomycin is one of the most widely used antibiotics for treating serious Gram-positive infections in children. Few clinical studies have examined the potential risk factors for treatment failure in children receiving vancomycin. The objectives of this study were to evaluate the relationships between vancomycin trough concentration and treatment outcomes in Chinese paediatric patients with suspected Gram-positive infections and to identify baseline characteristics that may affect treatment failure associated with vancomycin use...
August 31, 2016: Journal of Clinical Pharmacy and Therapeutics
A Jeong Kim, Ju-Yeun Lee, Soo An Choi, Wan Gyoon Shin
Although vancomycin concentrations in neurosurgical patients tend to be lower following standard dosing compared with other patient populations, factors influencing vancomycin pharmacokinetics in neurosurgical patients are poorly understood. In this study, pharmacokinetic (PK) parameters in neurosurgical and non-neurosurgical patients were compared. Furthermore, factors influencing vancomycin PK alterations, including those known to augment renal clearance, were determined. Routine therapeutic drug monitoring data from neurosurgical and non-neurosurgical patients were retrospectively collected...
October 2016: International Journal of Antimicrobial Agents
John P Prybylski
Effective treatment of complicated methicillin-resistant Staphylococcus aureus (MRSA) infections with vancomycin requires a 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio of at least 400. To ensure goal AUC24 has been reached requires either dosing to concentrations strongly associated with nephrotoxicity, measurement of patient-specific pharmacokinetics, or use of Bayesian statistics. In this study, we show a method of determining patient-specific pharmacokinetics and dosing to therapeutic AUC24 while minimizing potentially toxic concentrations, guided by only trough measurements...
July 7, 2016: Clinical Pharmacokinetics
Elliott Bennett-Guerrero, Harold S Minkowitz, Alvaro M Segura-Vasi, Jorge E Marcet, Jennifer A White, G Ralph Corey, Kent S Allenby
BACKGROUND: Despite numerous interventions promulgated by the Surgical Care Improve Project (SCIP) and other organizations, surgical site infection (SSI) continues to be a significant medical problem. DFA-02 is a novel bioresorbable modified-release gel consisting of both gentamicin (16.8 mg/mL) and vancomycin (18.8 mg/mL) to be applied during surgical incision closure for the prevention of SSIs. The following double-blind phase 2a trial was designed to test the safety and tolerability of DFA-02...
2016: Perioperative Medicine
Oluwatoyin Bamgbola
In recent times the use of larger doses of vancomycin aimed at curbing the increasing incidence of resistant strains of Staphylococcus aureus has led to a wider report of acute kidney injury (AKI). Apart from biological plausibility, causality is implied by the predictive association of AKI with larger doses, longer duration, and graded plasma concentrations of vancomycin. AKI is more likely to occur with the concurrent use of nephrotoxic agents, and in critically ill patients who are susceptible to poor renal perfusion...
June 2016: Therapeutic Advances in Endocrinology and Metabolism
(no author information available yet)
Vancomycin and teicoplanin, two glycopeptides, are intravenous antibiotics of choice for severe cutaneous infections possibly due to Gram-positive bacteria resistant to other antibiotics. Dalbavancin, a new glycopeptide antibiotic closely related to teicoplanin, is authorised in the European Union for intravenous treatment of acute infections of the skin and soft tissues. Dalbavancin has not been assessed in patients with infections resistant to other glycopeptide antibiotics. Dalbavancin was similarly effective to comparator antibiotics, including vancomycin, in five trials including more than 2800 patients...
May 2016: Prescrire International
ManShan C Tong, Christopher S Wisniewski, Bethany Wolf, John A Bosso
OBJECTIVE: Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution's clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. DESIGN: Retrospective electronic medical records review. METHODS: The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011, and August 31, 2014, with ICD-9 codes for MRSA and pneumonia...
July 2016: Pharmacotherapy
Naglaa A Bayomy, Eman Z Abdelaziz, Mona A Said, Marwa S Badawi, Reda H El-Bakary
Vancomycin-induced nephrotoxicity has been reported to occur in 5%-25% of patients who were administered with it. Several natural antioxidants were found to be effective against drug-induced toxicity. We evaluated the possible protective effects of spirulina and pycnogenol alone or in combination on vancomycin-induced renal cortical oxidative stress. Forty-nine rats were randomly divided into 7 groups: group I, control; group II, received spirulina 1000 mg/kg per day; group III, received pycnogenol 200 mg/kg per day; group IV, received vancomycin 200 mg/kg per day every 12 h; group V, (spirulina + vancomycin); group VI, (pycnogenol + vancomycin); and group VII, (pycnogenol + spirulina + vancomycin)...
August 2016: Canadian Journal of Physiology and Pharmacology
Ara Ko, Megan Y Harada, Galinos Barmparas, Jessica Jay, Beatrice J Sun, Eric Chen, Devorah Mehrzadi, Bansuri Patel, Russell Mason, Eric J Ley
BACKGROUND: Supratherapeutic vancomycin trough levels are common after trauma and associated with both increased acute kidney injury (AKI) and mortality. We sought to limit the adverse effects of vancomycin in trauma patients through more frequent trough monitoring. METHODS: Beginning in January 2011, trauma patients treated with vancomycin had trough levels (VT) monitored daily until steady state was reached. Trauma patients admitted from January 2011 to May 2015 (POST) were compared with those admitted from January 2006 to December 2010 (PRE)...
August 2016: Journal of Trauma and Acute Care Surgery
Laurent Bourguignon, Yoann Cazaubon, Guillaume Debeurme, Constance Loue, Michel Ducher, Sylvain Goutelle
Since the 1950s, vancomycin has remained a reference treatment for severe infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus Vancomycin is a nephrotoxic and ototoxic drug mainly eliminated through the kidneys. It has a large interindividual pharmacokinetic variability, which justifies monitoring its plasma concentrations in patients. This is especially important in patients aged over 80 years, who frequently have renal impairment. However, the pharmacokinetics of vancomycin in this population is very poorly described in the literature...
August 2016: Antimicrobial Agents and Chemotherapy
S Fukumori, Y Tsuji, A Mizoguchi, H Kasai, T Ishibashi, N Iwamura, H To
WHAT IS KNOWN AND OBJECTIVE: The pharmacokinetic-pharmacodynamic parameter that best predicts the efficacy of vancomycin is the ratio of the area under the concentration versus time curve (AUC) to the minimum inhibitory concentration (MIC). A 24-h AUC (AUC24 )/MIC ratio ≥ 400 was recommended in an American consensus review, but vancomycin treatment occasionally fails despite maintenance of AUC24 /MIC ≥ 400. We evaluated the association between clinical efficacy of vancomycin and two novel pharmacokinetic parameters, the 'area under the trough level' (AUTL) and the 'area above the trough level' (AATL), in hospitalized elderly patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia...
August 2016: Journal of Clinical Pharmacy and Therapeutics
Jae Hoon Lee, Chang-Seop Lee
Arbekacin is a broad-spectrum aminoglycoside used to treat methicillin-resistant Staphylococcus aureus (MRSA). Arbekacin has antibacterial activities against high-level gentamicin-resistant Enterococci, multidrug-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii et al. Here, we reviewed in vitro data on arbekacin in Staphylococci and Gram-negative microorganisms. We also reviewed clinical studies for clinical efficacy and microbiologic efficacy data in patients with identified MRSA and suspected MRSA infections...
March 2016: Infection & Chemotherapy
Itay M Sabler, Matitiahu Berkovitch, Judith Sandbank, Eran Kozer, Zahi Dagan, Michael Goldman, Hilla Bahat, Kobi Stav, Amnon Zisman, Baruch Klin, Ibrahim Abu-Kishk
It has been suggested that oxidative stress is a potential mechanism for vancomycin-induced nephrotoxicity and hyperbaric oxygen therapy (HBO) has been shown to be effective in treating renal toxicity that has been pharmacologically induced in animal models. The aim of this study was to investigate the effect of HBO therapy on vancomycin-induced nephrotoxicity in rats. The study group comprised 36 Sprague Dawley male rats. We treated 30 with 500 mg/kg of intraperitoneal vancomycin once a day for 7 days. Half of these rats received a daily 1-hour treatment with HBO at 2 Atmospheres (ATM) on the same 7 days and formed the HBO+ group...
2016: PloS One
Cory M Hale, Robert W Seabury, Jeffrey M Steele, William Darko, Christopher D Miller
PURPOSE: To determine whether there is an association between higher vancomycin trough concentrations and attainment of a calculated area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ≥400. METHODS: A retrospective analysis was conducted among vancomycin-treated adult patients with a positive methicillin-resistant Staphylococcus aureus (MRSA) culture. Attainment of a calculated AUC/MIC ≥400 was compared between patients with troughs in the reference range of 15 to 20 mg/L and those with troughs in the following ranges: <10, 10 to 14...
April 12, 2016: Journal of Pharmacy Practice
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