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A Reference Broth Microdilution Method for Dalbavancin In Vitro Susceptibility Testing of Bacteria that Grow Aerobically
Published on: September 9, 2015
Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981
Abstract:
A retrospective chart review of 98 patients treated with 100 courses of intravenous vancomycin was undertaken to better define its toxicity. Most of the patients carried diagnoses of Staphylococcus aureus or Staphylococcus epidermidis infection. Auditory toxicity was not seen, and fever and rash occurred in only 1 to 3% of the subjects. Phlebitis was noted in 13% of the cases and required discontinuation of therapy in 2%. Therapy was complicated by neutropenia (polymorphonuclear leukocyte count, less than or equal to 1,000 cells per cm3) in 2% of the patients but was rapidly reversible. Nephrotoxicity was uncommon (5%) and reversible in subjects receiving vancomycin alone, even when the therapy was continued. However, 35% of the patients receiving vancomycin with an aminoglycoside developed significant elevations in serum creatinine. Although this high incidence may have been due to the patient population selected or to the aminoglycoside therapy alone, the possibility of additive toxicity between vancomycin and the aminoglycosides should be considered.
Insights
Vancomycin is generally well-tolerated for Staphylococcus infections, with low rates of fever, rash, and neutropenia. However, combining vancomycin with aminoglycosides may increase the risk of nephrotoxicity.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Intravenous vancomycin is a critical antibiotic for treating Gram-positive bacterial infections, particularly those caused by Staphylococcus species.
- Understanding vancomycin's toxicity profile is essential for optimizing patient care and minimizing adverse events.
Purpose of the Study:
- To retrospectively evaluate the toxicity of intravenous vancomycin in patients with Staphylococcus aureus or Staphylococcus epidermidis infections.
- To identify potential risk factors and co-administered drugs associated with vancomycin-related adverse events.
Main Methods:
- Retrospective chart review of 98 patients receiving 100 courses of intravenous vancomycin.
- Analysis of adverse events including auditory toxicity, fever, rash, phlebitis, neutropenia, and nephrotoxicity.
Main Results:
- Low incidence of auditory toxicity (0%), fever (1-3%), rash (1-3%), and neutropenia (2%).
- Phlebitis occurred in 13% of cases, leading to discontinuation in 2%.
- Vancomycin alone showed uncommon (5%) and reversible nephrotoxicity; however, concurrent aminoglycoside use increased serum creatinine elevations to 35%.
Conclusions:
- Intravenous vancomycin exhibits a favorable safety profile for Staphylococcus infections, with rare auditory or systemic toxicities.
- Concurrent administration of vancomycin and aminoglycosides warrants careful monitoring due to a potential for additive nephrotoxicity.
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