Issue: 2011 > September > review

Vancomycin nephrotoxicity: myths and facts

A. Gupta, M. Biyani, A. Khaira


Vancomycin is a key antibiotic in the management of
severe Gram-positive infections. Recent emergence of
methicillin-resistant staphylococcal strains with reduced
susceptibility to vancomycin has prompted internists to
administer high-dose treatment to achieve trough levels
of 15 to 20 mg/l. Such high doses might be causative
in nephrotoxicity. The risk further increases in patients
who are critically ill and are on vasopressor support
and/or concomitant nephrotoxic agents, with baseline
deranged renal function, undergoing prolonged duration
of therapy and are obese. However, data are insufficient
to recommend the superiority of continuous infusion
regimens as compared with intermittent dosing. This
review discusses the literature pertaining to vancomycin nephrotoxicity.