Vancomycin is a glycopeptide antibiotic commonly used in combination with other β‐lactam antibiotics, such as piperacillin–tazobactam (PTZ), as the initial empiric treatment for moderate–severe infections whenever coverage for both methicillin‐resistant Staphylococcus aureus and Pseudomonas aeruginosa is required.Vancomycin use has long been reported to be associated with nephrotoxicity. The development of acute kidney injury (AKI) in hospitalized patients can increase both morbidity and mortality. The published incidence of vancomycin‐induced AKI ranges from 5% to 43%, depending largely on the population studied, the presence or absence of confounding risk factors, and definitions of nephrotoxicity. In contrast, the reported incidence of AKI in patients receiving PTZ monotherapy is <1%.Several risk factors that increase the risk of vancomycin nephrotoxicity have been identified, including concomitant nephrotoxic agents, pre‐existing renal dysfunction, concomitant critical illness, increasing treatment duration, higher vancomycin serum trough concentration (>15 μg/mL), and total vancomycin dosage >4 g/day in adults.The exact mechanism of vancomycin nephrotoxicity is still uncertain. Vancomycin is primarily eliminated by glomerular filtration and some active tubular secretion. Postulated mechanisms include oxidative stress, complement‐mediated inflammation, and necrosis of the renal tubule with vancomycin accumulation. Published reports evaluating PTZ nephrotoxic potential are sparse. PTZ has been implicated in AKI through acute interstitial nephritis (AIN)
Pediatrics International – Wiley
Published: Jan 1, 2018
Keywords: ; ; ; ;
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