Recent changes in vancomycin use in renal failure.
Vancomycin is a key tool in the treatment of serious Gram-positive infections. A progressive increase in vancomycin resistance with consequent treatment failure has been observed in staphylococci. Therefore, new dosing guidelines advocating much higher vancomycin doses have been issued. Target trough levels of 15-20 microg/ml are proposed. Whether and how these targets can be achieved in patients with chronic kidney disease or those on dialysis are still under evaluation. The higher vancomycin doses to achieve these treatment targets carry a substantial risk for nephrotoxicity. This risk is incremental with higher trough levels and longer duration of vancomycin use. Critically ill patients, patients receiving concomitant nephrotoxic agents, and patients with already compromised renal function are particularly at risk for vancomycin-induced nephrotoxicity.
Vandecasteele
Stefaan J
SJ
Division of Nephrology and Infectious Diseases, Department of Internal Medicine, AZ Sint-Jan Brugge-Oostende AV, 8000 Brugge, Belgium. Stefaan.Vandecasteele@azbrugge.be
De Vriese
An S
AS
D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000188:drug therapy; D007677:Kidney Function Tests; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000139:chemically induced / Q000188:drug therapy; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000139:chemically induced / Q000188:drug therapy*; D013210:Staphylococcus; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020713:Vancomycin Resistance
D014640:Vancomycin