Related Experiment Video
Updated: Feb 18, 2026
Intrarenal Injection of Escherichia coli in a Rat Model of Pyelonephritis
Published on: July 18, 2017
Pediatric acute kidney injury induced by concomitant vancomycin and piperacillin-tazobactam
Manal Abouelkheir1, Sarah Alsubaie2
1Pediatric Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Background:
Vancomycin is very commonly used in combination with piperacillin-tazobactam (PTZ) as the initial empiric treatment for moderate-severe infection, whenever coverage for both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is required. The combination of vancomycin and PTZ in adults has recently been reported to significantly increase the risk of acute kidney injury (AKI) relative to vancomycin monotherapy; such reports in pediatrics, however, are sparse.
Methods:
A retrospective chart review was conducted of pediatric patients, aged 0-14 years, who were admitted to the general wards or intensive care unit and developed AKI after receiving vancomycin and PTZ concomitantly for >48 h. AKI is defined as a decrease in estimated glomerular filtration rate ≥50% from baseline. Cases were identified by reviewing the Adverse Drug Reaction program database at King Saud University Medical City in Saudi Arabia from January 2015 to June 2016.
Results:
Eight children admitted to the present hospital and who received concomitant vancomycin and PTZ treatment for pneumonia (n = 7) or febrile neutropenia (n = 1) developed drug-induced nephrotoxicity. Drug Interaction Probability Scale (DIPS) score for causation assessment was 9 in all cases (highly probable).
Conclusion:
Caution in utilizing the combination of vancomycin and PTZ is warranted in pediatric patients. Health-care professionals should be vigilant if this combination is to be initiated, and ensure close monitoring of renal function. Antibiotic therapy de-escalation should be considered as soon as culture results are available.
Insights
Vancomycin combined with piperacillin-tazobactam (PTZ) may increase acute kidney injury (AKI) risk in children. Close renal function monitoring is crucial when using this antibiotic combination in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Vancomycin and piperacillin-tazobactam (PTZ) combination is common for moderate-severe infections requiring coverage for MRSA and Pseudomonas aeruginosa.
- Recent adult studies link vancomycin-PTZ to increased acute kidney injury (AKI) risk, but pediatric data are limited.
Purpose of the Study:
- To investigate the incidence and probability of drug-induced nephrotoxicity in pediatric patients receiving concomitant vancomycin and PTZ.
Main Methods:
- Retrospective chart review of pediatric patients (0-14 years) who developed AKI (≥50% decrease in eGFR) after >48 hours of vancomycin-PTZ.
- Data sourced from the Adverse Drug Reaction program database at King Saud University Medical City (Jan 2015 - June 2016).
Main Results:
- Eight pediatric patients developed drug-induced nephrotoxicity while on vancomycin and PTZ for pneumonia or febrile neutropenia.
- The Drug Interaction Probability Scale (DIPS) indicated a highly probable causal link (score of 9) in all identified cases.
Conclusions:
- Caution is advised when prescribing vancomycin and PTZ concurrently in pediatric patients due to potential nephrotoxicity.
- Healthcare professionals must vigilantly monitor pediatric renal function and consider antibiotic de-escalation post-culture results.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:29Acute Kidney Injury III: Clinical Manifestations
01:22Acute Kidney Injury VI: Nursing Management