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Updated: Feb 14, 2026

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Comparison of the Nephrotoxicity of Vancomycin in Combination With Cefepime, Meropenem, or Piperacillin/Tazobactam: A

Brandon P Mullins1, C Joseph Kramer2, Billie J Bartel3

  • 11 St Luke's Hospital, Chesterfield, MO, USA.

The Annals of Pharmacotherapy
|February 15, 2018
PubMed
Abstract

Insights

The combination of vancomycin and piperacillin/tazobactam significantly increases the risk of acute kidney injury compared to other broad-spectrum antibiotics. Clinicians should be cautious when prescribing this antibiotic combination.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Broad-spectrum antibiotics are frequently used for nosocomial infections.
  • Previous studies suggest a potential link between vancomycin-piperacillin/tazobactam and acute kidney injury.

Purpose of the Study:

  • To compare the incidence of nephrotoxicity in patients receiving intravenous vancomycin with cefepime, meropenem, or piperacillin/tazobactam.

Main Methods:

  • A prospective, multicenter observational study.
  • Included 242 adult patients receiving vancomycin for ≥72 hours with cefepime, meropenem, or piperacillin/tazobactam.

Main Results:

  • Acute kidney injury incidence was significantly higher with vancomycin-piperacillin/tazobactam (29.8%) versus vancomycin-cefepime/meropenem (8.8%).
  • Patients on vancomycin-piperacillin/tazobactam were 6.7 times more likely to develop acute kidney injury.

Conclusions:

  • Vancomycin combined with piperacillin/tazobactam significantly elevates acute kidney injury risk.
  • Vigilance is recommended when using this antibiotic regimen.
Keywords:
antibioticsbeta-lactamscephalosporinsnephrotoxicityvancomycin

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