Related Experiment Video

Updated: May 16, 2026

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
11:28

A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically

Published on: September 9, 2015

Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that

S J van Hal1, D L Paterson, T P Lodise

  • 1Department of Microbiology & Infectious Diseases, Royal Prince Alfred Hospital, Sydney, Australia. Sebastian.vanhal@sswahs.nsw.gov.au

Antimicrobial Agents and Chemotherapy
|November 21, 2012
PubMed

Insights

Higher vancomycin troughs (15-20 mg/L) increase nephrotoxicity risk. This systematic review found higher vancomycin troughs are linked to increased odds of kidney damage, emphasizing careful dosing.

Area of Science:

  • Pharmacology
  • Nephrology
  • Clinical Pharmacy

Background:

  • Recent guidelines advocate intensive vancomycin dosing (troughs 15-20 mg/L) to optimize treatment outcomes.
  • Increased reports of vancomycin-induced nephrotoxicity have emerged with these intensive regimens.

Purpose of the Study:

  • To systematically evaluate the nephrotoxicity risk associated with maintaining higher vancomycin trough concentrations in clinical practice.

Main Methods:

  • A systematic literature review of studies published between 1996 and April 2012 was conducted.
  • Searches included PubMed, Embase, Cochrane Controlled Trial Registry, and Medline databases.
  • Fifteen studies met inclusion criteria for analysis according to Cochrane guidelines.

Main Results:

  • Higher vancomycin troughs (≥ 15 mg/L) were significantly associated with increased odds of nephrotoxicity (OR, 2.67; 95% CI, 1.95-3.65) compared to lower troughs (<15 mg/L).
  • This association persisted when analyzing initial trough concentrations and after adjusting for known risk factors.
  • Increased nephrotoxicity risk was also observed with longer vancomycin therapy durations.

Conclusions:

  • A clear exposure-nephrotoxicity relationship exists for vancomycin.
  • Higher trough concentrations and longer treatment durations increase the probability of vancomycin-induced kidney injury.
  • Vancomycin-induced nephrotoxicity is generally reversible, with rare need for dialysis.

More Related Videos

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials06:18

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials

Published on: March 3, 2023

Related Concept Videos

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations01:15

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
Estimation of k and VD of Aminoglycosides01:20

Estimation of k and VD of Aminoglycosides

Aminoglycosides are a class of antibiotics used to treat various bacterial infections. Clinicians must determine the elimination rate constant (k) and volume of distribution (VD) to optimize therapeutic efficacy and minimize toxicity. The k value represents the rate at which the drug is removed from the body, and the VD reflects the degree to which the drug distributes into body tissues. Accurately estimating these parameters allows healthcare professionals to tailor drug dosing to individual...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...