The possibility of developing nephrotoxicity with vancomycin was shown earlier, but most doctors do not consider this adverse drug reaction to be significant and classify the drug as relatively safe. At the same time, the trend towards the appointment of vancomycin in high doses in recent years requires a change of approach to assess the safety of the drug.

The standard dosing schedule for vancomycin is to keep your blood level in the range of 5 mg / l to 15 mg / l, with the exception of a number of infections (meningitis, nosocomial pneumonia, and ventilator-associated pneumonia). ), in which the recommended concentrations are higher - 15-20 mg / l. The widespread use of the drug in the treatment of the above infections, as well as the increased frequency of infections caused by methicillin-resistant strains of Staphylococcus aureus (MRSA), have resulted in a increased frequency of use of this drug at doses exceeding standard doses. However, the risk of developing adverse drug reactions, including kidney damage, when using vancomycin in large doses has not been fully studied.

A retrospective study by Nguyen et al., Presented at the 47th annual intersectoral conference on antimicrobials and chemotherapy (ICAAC) presented at the 47th annual interdisciplinary conference on antimicrobials and chemotherapy (ICAAC), assessed the incidence of nephrotoxicity during treatment with vancomycin in 218 patients, including 130 patients made up of the study group (the level of the drug in the blood is more than 15 mg / l), 88 - the control group (the level of the drug in the blood is 5-15 mg / l).

According to the data obtained, the incidence of nephropathy in the study group reached 18% compared to 6% in the control group. The significant predictors of the development of nephrotoxicity during treatment with vancomycin were the duration of treatment (p = 0.016) and the average concentration of the drug in the blood (p = 0.012).

The results presented are consistent with data from previous studies, in which a direct relationship has been shown between the use of vancomycin in high doses and the risk of developing nephrotoxicity, which reached 58.8% in the one of the studies, and a significant increase in the risk was noted in patients, the concentration of the drug in the blood exceeding 15 mg / l.

Based on the data, the researchers recommend careful monitoring of kidney function in patients receiving high-dose vancomycin therapy.