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Updated: Dec 8, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Nephrotoxicity of concomitant piperacillin/tazobactam and teicoplanin compared with monotherapy

J D Workum1,2, C Kramers2, E Kolwijck3,4

  • 1Department of Intensive Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.

The Journal of Antimicrobial Chemotherapy
|September 18, 2020
PubMed
Abstract

Insights

Combining piperacillin/tazobactam with teicoplanin may increase acute kidney injury (AKI) risk. However, the overall impact on renal function is minimal, suggesting this combination is likely safe for patients.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Piperacillin/tazobactam combined with vancomycin is linked to reduced renal function.
  • Teicoplanin, a vancomycin analog, is used in similar clinical scenarios.
  • The renal safety of combining piperacillin/tazobactam with teicoplanin requires investigation.

Purpose of the Study:

  • To evaluate the association between piperacillin/tazobactam plus teicoplanin combination therapy and renal function decline.
  • To compare the incidence of acute kidney injury (AKI) between monotherapy and combination therapy.

Main Methods:

  • A retrospective cohort study analyzed data from 4202 adult patients.
  • Patients received piperacillin/tazobactam, teicoplanin, or the combination therapy.
  • Primary outcome was AKI incidence at 48-72 hours; secondary outcome was serum creatinine change.

Main Results:

  • The incidence of AKI was 11.7% for piperacillin/tazobactam + teicoplanin, versus 5.4% for piperacillin/tazobactam and 3.4% for teicoplanin.
  • A slight increase in serum creatinine was observed with the combination therapy (+1.61%), while monotherapy showed a decrease.
  • These trends persisted after adjusting for confounders.

Conclusions:

  • Piperacillin/tazobactam + teicoplanin is associated with a higher AKI prevalence than monotherapy.
  • The clinical significance of the observed renal function decline with combination therapy appears limited.
  • The combination of piperacillin/tazobactam and teicoplanin is likely safe for clinical use.

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