Excess Risk for Nephrotoxicity with Vancomycin-Piperacillin: Are We Beating a Dead Workhorse?

Yet another study demonstrates increased acute kidney injury from vancomycin plus piperacillin compared with either drug alone.

Vancomycin plus piperacillin-tazobactam is a workhorse antimicrobial regimen for many clinical conditions. Nonetheless, in association with more-aggressive dosing aimed at higher serum trough concentrations, vancomycin nephrotoxicity has become increasingly evident — especially when this agent is combined with penicillins such as piperacillin or flucloxacillin. The mechanism of penicillin-enhanced vancomycin nephrotoxicity remains controversial.

Researchers queried the WHO VigiBase of individual case safety reports from 1997 to 2019 in a disproportionality analysis comparing reports of acute kidney injury (AKI) associated with vancomycin plus piperacillin, cefepime, or meropenem. During the study period, 6016 cases of vancomycin-linked AKI w…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases