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Does Piperacillin-Tazobactam Increase the Risk of Nephrotoxicity when Used with Vancomycin: A Meta-Analysis of

Chadwick K Mellen, Jennifer E Ryba, Joseph P Rindone1

  • 1Clinical Pharmacy Section, Northern Arizona VA Health Care System, 500 N HWY 89, Prescott, Arizona 86313;. United States.

Current Drug Safety
|October 28, 2016
PubMed
Abstract

Insights

Adding piperacillin-tazobactam to vancomycin increases the risk of kidney damage. This meta-analysis confirms a higher incidence of nephrotoxicity in patients receiving this combination therapy.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Observational studies suggest a potential link between piperacillin-tazobactam and vancomycin combination therapy and increased nephrotoxicity.
  • Conflicting data exists regarding the actual risk of kidney damage with this drug combination.

Purpose of the Study:

  • To conduct a meta-analysis to evaluate the incidence of nephrotoxicity when piperacillin-tazobactam is administered with vancomycin.
  • To synthesize evidence from existing studies to clarify the safety profile of this combination therapy.

Main Methods:

  • Systematic review of multiple databases including PubMed, EMBASE, Cochrane Central, and Google Scholar.
  • Inclusion of full-length retrospective and prospective studies specifically designed to assess nephrotoxicity from combined piperacillin-tazobactam and vancomycin use.
  • Meta-analysis of data from six identified observational trials involving 963 patients.

Main Results:

  • The meta-analysis revealed a statistically significant increase in nephrotoxicity incidence when piperacillin-tazobactam/vancomycin was compared to control groups.
  • No significant differences in the need for renal replacement therapy were observed between the combination therapy group and control groups.
  • The combination of piperacillin-tazobactam with vancomycin showed a higher risk of kidney damage (2.26 95% CI 1.41-3.63, p=0.0007).

Conclusions:

  • The combination of piperacillin-tazobactam with vancomycin is associated with an increased risk of nephrotoxicity.
  • This risk is elevated compared to vancomycin monotherapy or vancomycin combined with cefepime or meropenem.
  • Clinicians should consider this increased nephrotoxicity risk when prescribing piperacillin-tazobactam and vancomycin concurrently.
Keywords:
Cefepimecombinationmeropenemmeta-analysisnephrotoxicitypiperacillin-tazobactamvancomycin

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