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Lack of nephrotoxicity in pediatric patients receiving concurrent vancomycin and aminoglycoside therapy
Insights
Nephrotoxicity is uncommon in pediatric patients receiving vancomycin and gentamicin therapy when drug levels are monitored. This study found no evidence of renal toxicity in infants and children receiving these antibiotics.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Retrospective studies indicate a significant risk of nephrotoxicity (up to 35%) in adult patients on vancomycin and aminoglycosides.
- Limited data exist on nephrotoxicity incidence in pediatric populations, particularly with close therapeutic drug monitoring.
Purpose of the Study:
- To prospectively evaluate the incidence of nephrotoxicity in pediatric patients receiving combined vancomycin and gentamicin therapy.
- To assess the safety profile of concomitant vancomycin and gentamicin in infants and children under monitored conditions.
Main Methods:
- Prospective evaluation of 90 pediatric patients (61 infants <1 year, 29 children >1 year).
- Administration of concomitant vancomycin and gentamicin for 3-38 days with dose and serum concentration monitoring.
- Assessment of renal toxicity through serum creatinine levels and urinalysis.
Main Results:
- Serum creatinine levels remained stable throughout therapy (pre: 0.42, during: 0.40, post: 0.43 mg/dl; p > 0.1).
- No clinical or urinalysis evidence of renal toxicity was observed in the study cohort.
- Vancomycin and gentamicin serum concentrations were monitored within therapeutic ranges.
Conclusions:
- Combined vancomycin and gentamicin therapy appears safe regarding nephrotoxicity in pediatric patients when monitored.
- Close monitoring of serum concentrations, especially for gentamicin, is crucial for preventing adverse renal effects in children.
Abstract:
Based on retrospective studies, nephrotoxicity may occur in as many as 35% of adult patients receiving vancomycin and an aminoglycoside. Limited data are available about the incidence of nephrotoxicity in pediatric patients, especially when drug therapy is closely monitored. We prospectively evaluated the potential of nephrotoxicity in 90 infants and children (61 less than 1 year and 29 greater than 1 year of age) receiving concomitant vancomycin and gentamicin for a duration of 3 to 38 (mean 9) days. Vancomycin and gentamicin doses ranged from 20 to 60 (mean 35) mg/kg/day and 2.5 to 14 (mean 6.5) mg/kg/day. Peak and trough serum concentration of vancomycin ranged from 10 to 55 and 2 to 18 micrograms/ml, respectively. Gentamicin peak and trough serum concentration ranged from 4 to 9 and 0.5 to 2.0 micrograms/ml, respectively. Serum creatinine concentration prior to, during and at the end of therapy averaged 0.42, 0.40, and 0.43 mg/dl (p greater than 0.1), respectively. Clinical status and urinalysis results showed no evidence of renal toxicity. These data suggest that nephrotoxicity is uncommon in pediatric patients receiving a combined therapy with vancomycin and gentamicin, particularly when serum concentrations of gentamicin are within therapeutic range.