Related Experiment Video

Updated: May 2, 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

33.2K

High versus low vancomycin serum trough regimen for Gram-positive infections: a meta-analysis

Long Meng, Yun Fang, Yongfei Chen

    Journal of Chemotherapy (Florence, Italy)
    |March 20, 2014
    PubMed

    Insights

    High vancomycin trough concentrations (≧15 mg/l) did not improve treatment failure or mortality rates. However, these higher levels significantly increased the risk of vancomycin-induced nephrotoxicity in adult patients.

    Area of Science:

    • Pharmacology
    • Clinical Medicine
    • Nephrology

    Background:

    • Vancomycin is a critical antibiotic for treating serious Gram-positive infections.
    • Optimizing vancomycin dosing is essential to balance efficacy and toxicity.
    • High vancomycin serum trough concentrations are often targeted, but their impact on outcomes requires further evaluation.

    Purpose of the Study:

    • To evaluate the clinical outcomes and nephrotoxicity associated with high vancomycin serum trough concentrations (≧15 mg/l) in adult patients.
    • To compare treatment failure, all-cause mortality, and nephrotoxicity between high and low vancomycin trough concentration groups.

    Main Methods:

    • Systematic literature search of MEDLINE, Cochrane Library, and CNKI.
    • Inclusion of 17 studies for meta-analysis.
    • Analysis of clinical outcomes including treatment failure, all-cause mortality, and vancomycin-induced nephrotoxicity.

    Main Results:

    • No significant difference in overall treatment failure (RR 0.91, P=0.57) or all-cause mortality (RR 1.14, P=0.46) between high and low trough groups.
    • A significant reduction in treatment failure was observed in the bacteremia subgroup with high trough concentrations (RR 0.72, P=0.001).
    • High vancomycin trough concentrations were significantly associated with an increased risk of nephrotoxicity (RR 2.06, P<0.00001).

    Conclusions:

    • High vancomycin trough concentrations (≧15 mg/l) are not demonstrably superior to lower concentrations in reducing overall treatment failure or mortality.
    • The elevated trough levels significantly elevate the risk of developing vancomycin-induced nephrotoxicity.
    • Clinical practice should carefully consider the balance between potential benefits in specific subgroups and the increased risk of kidney injury.
    Keywords:
    Antimicrobial treatment,Efficacy,Meta-analysis,Mortality,Nephrotoxicity,Trough,Vancomycin

    More Related Videos

    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

    4.4K
    Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses11:17

    Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

    Published on: August 30, 2018

    11.6K

    Related Concept Videos

    Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence01:22

    Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence

    Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
    259
    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...
    335
    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...
    386
    Dosage Interval and Administration Route: Determination Methods01:19

    Dosage Interval and Administration Route: Determination Methods

    A medication’s effectiveness largely depends on its appropriate dosage and the route of administration. Dosage ensures that a sufficient drug concentration is maintained in the bloodstream to elicit the desired therapeutic effect without causing toxicity. The route of administration affects the drug's bioavailability, rate of absorption, and onset of action, which are crucial for achieving optimal therapeutic outcomes. Drug dosage calculations are critical to tailoring therapy to...
    564
    Clinical Significance of Antibiotic Resistance01:25

    Clinical Significance of Antibiotic Resistance

    Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within...
    90
    Inhibitors of Gram-positive Cell Wall Synthesis01:23

    Inhibitors of Gram-positive Cell Wall Synthesis

    Bacterial cell walls are typically rigid structures composed mainly of peptidoglycan, a mesh-like polymer that provides mechanical strength and maintains cell shape. The synthesis of peptidoglycan is a crucial process in bacterial growth and serves as a primary target for many antibiotics.Mechanism of Action of Beta-Lactam AntibioticsBeta-lactam antibiotics, such as penicillin, inhibit peptidoglycan synthesis in actively growing cells. These antibiotics share a characteristic four-membered...
    191