Nephrotoxicity of Vancomycin and Teicoplanin Alone and in Combination with an Aminoglycoside

Background and Purpose: Vancomycin and teicoplanin are considered first line medications for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections but these agents are also associated with the side-effect of nephrotoxicity. This study investigated the association between treatment with vancomycin monotherapy, teicoplanin monotherapy and combinations of these drugs with aminoglycoside antibiotics, and the occurrence of nephrotoxicity. Methods: Patients treated with vancomycin or teicoplanin, either alone or in combination with an aminoglycoside antibiotic from June to December 2003 were included. Data analyzed included age, gender, renal function (before and after drug administration), days of antibiotics administration, location of infection, other antibiotics used in combination factors affecting renal function. Results: A total of 96 patients, comprising 50 males and 46 females, with a mean age of 67.97±13.43 years were included. Multivariate logistic regression analysis revealed no association between treatment with vancomycin or teicoplanin and gender, chronic renal function impairment, dialysis treatment, diabetes, hypertension, mean age, combination with an aminoglycoside, or treatment in the ICU. Among the 28 courses of vancomycin treatment for which there were adequate serum concentration monitoring data, 16 (57.1%) courses resulted in high trough vancomycin concentration, 8 (28.6%) courses were in the normal range, and 4 (14.3%) courses were low trough concentration. Vancomycin trough serum concentrations were significantly higher in ICU patients (p=0.003). Conclusion: There was no significant difference (p＞0.05) in nephrotoxicity among patients treated with vancomycin or teicoplanin alone or in combination with an aminoglycoside. Vancomycin trough serum concentrations were highest in critically ill patients. Additional serum concentration monitoring in ICU patients was therefore advised after the use of vancomycin, in order to make necessary dosage adjustment. This can avoid unnecessary drug expenditure and reduce the likelihood of side-effects.