Nephrotoxicity with Combination Vancomycin-Aminoglycoside Therapy

OBJECTIVES The purpose of this paper is to review the medical literature regarding vancomycinaminoglycoside induced nephrotoxicity in the pediatric population.

METHODS MEDLINE (1966 through June 2005), EMBASE (1980 through 1st quarter 2005), and International Pharmaceutical Abstracts databases were reviewed using appropriate search terms for articles related to nephrotoxicity with vancomycin and aminoglycoside use. Case reports, letters to editors, retrospective and prospective studies evaluating nephrotoxicity with the agents in pediatric patients were compiled and summarized. Studies in animals and adults were also briefly reviewed.

RESULTS One case report, two letters to editors, one retrospective study, and two prospective studies evaluated the nephrotoxicity of combination aminoglycoside and vancomycin therapy in pediatric patients. The collective number of patients in the reports was 165. Patients ranged in age from 3 days to 19 years old. Four out of the six reports, including all of the prospective studies, concluded that combination therapy does not potentiate nephrotoxicity.

CONCLUSIONS Although vancomycin and the aminoglycosides have been associated with drug induced nephrotoxicity, reports in the literature do not appear to support the idea that the combination of vancomycin and an aminoglycoside is more nephrotoxic than either medication alone.