High-Dose Intravenous Vancomycin May Cause Less Nephrotoxicity than Previously Reported

A study of 80 hospitalized adult patients with normal baseline renal function who received ≥4 g/day of intravenous vancomycin for ≥48 hours revealed the overall rate of nephrotoxicity was 6%. Trough concentrations >20 mg/L were observed in a similar proportion of patients who did and did not develop nephrotoxicity. The Clinical Therapeutics study found that patients who developed nephrotoxicity trended toward having a lower BMI, higher daily dose, longer duration of therapy, and greater exposure to intravenous contrast and nephrotoxic medications. In a multivariable analysis, the combination of intravenous contrast and nephrotoxic medications predicted nephrotoxicity, and duration of high-dose vancomycin was a significant confounder.