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PKP-012 Relationship between vancomycin trough concentrations and nephrotoxicity
  1. M Blanco Rivas1,
  2. P Nieto Guindo2,
  3. E Molina Cuadrado2,
  4. E Alvaro1,
  5. H Mateo Carrasco3,
  6. R Romero Dominguez1,
  7. V Faus Felipe1,
  8. JJ Arenas Villafranca1
  1. 1Hospital Costa del Sol, Pharmacy, Marbella, Spain
  2. 2Hospital Torrecárdenas, Pharmacy, Almeria, Spain
  3. 3Northampton Hospital, Pharmacy, Northampton, United Kingdom

Abstract

Background High vancomycin trough concentrations have been correlated with good anti-MRSA and other Gram-positive activity. However, nephrotoxicity rates vary among the different studies and optimal dosage regimens remain controversial.

Purpose To compare the incidence of vancomycin-related nephrotoxicity in patients with high (>15 mg/L) vs. low (<15 mg/L) trough concentrations.

Materials and methods Retrospective study (January 2009 – August 2013). Inclusion criteria: patients older than 18 years who had completed a course of vancomycin (duration ≥ 72 h), and had at least one steady-state (after 2 to 4 days of treatment) vancomycin trough concentration determined. According to their trough levels, the patients were included into one of the following categories: vancomycin trough <15 mg/L (hereafter group 1) and those with vancomycin trough ≥15 mg/L (hereafter group 2). Pharmacokinetic data were estimated using a Bayesian approach (Abbott Base PKS). Nephrotoxicity was defined as an increase in serum creatinine of 0.5 mg/dL or a >50% increase from the baseline for two consecutive determinations.

Results 30 patients included, 18 belonging to group 1 and 12 to group 2. Demographics: mean age 68.1, female 33%. Median (CI95%) pharmacokinetic data for groups 1 and 2 were: AUC = 446 [394–498] and 730 [(667–794], clearance = 3.9 L/h [3.3–4.5] and 2.3 L/h [2.0–2.7], dose = 1.806.mg [1.504–2.107] and 1.847.mg [1.680–2.015], and duration of treatment 11.6 days [9.3–13.9] and 16.5 days [13.9–19.1] respectively.

Nephrotoxicity rates in group 1 and 2 were 0 and 16% respectively. Treatment with concomitant nephrotoxic drugs was not related to vancomycin nephrotoxicity: none of the 5 patients treated simultaneously with aminoglycosides developed nephrotoxicity, all of them with vancomycin trough concentrations >15 mg/L.

Conclusions The incidence of nephrotoxicity was relatively low in patients with trough concentrations above 15 mg/L. A vancomycin dosage regimen aimed to maintain trough concentrations over 15 mg/L did not compromise renal function in our cohort. In addition, the episodes recorded were moderate in severity and reversible after vancomycin discontinuation. Nonetheless, a larger population would be necessary to address these and other safety issues.

No conflict of interest.

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