期刊
AMERICAN JOURNAL OF MEDICINE
卷 123, 期 2, 页码 -出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2009.05.031
关键词
Adverse events; Dose; Nephrotoxicity; Therapeutic drug monitoring; Vancomycin
资金
- National Center for Research Resources [KL2RR024983]
- National Institutes of Health
- National Institutes of Health Roadmap for Medical Research
Vancomycin-associated nephrotoxicity was reported in 0% to 5% of patients in the 1980s. This has been confirmed by numerous clinical trials comparing novel anti-methicillin-resistant Staphylococcus aureus agents with vancomycin at the Food and Drug Administration-approved dosage of I g every 12 hours. Treatment failures of vancomycin in patients with methicillin-resistant S. aureus infections have been reported despite in vitro susceptibility. These failures have led to the use of vancomycin doses higher than those approved by the Food and Drug Administration. Higher doses are being administered to achieve goal vancomycin trough concentrations of 10 to 20 mu g/mL recommended by several clinical practice guidelines endorsed by the Infectious Diseases Society of America. Recent studies suggest that increased rates of nephrotoxicity are associated with aggressive vancomycin dosing. These increased rates are confounded by concomitant nephrotoxins, renal insufficiency, or changing hemodynamics. These studies also have demonstrated that vancomycin's nephrotoxicity risk is minimal in patients without risk factors for nephrotoxicity. Clinicians unwilling to dose vancomycin in accordance with clinical practice guidelines should use an alternative agent because inadequate dosing increases the likelihood of selecting heteroresistant methicillin-resistant S. aureus isolates. (C) 2010 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2010) 123, 182.e1-182.e7
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