Ototoxicity from vancomycin

Antibiotics with activity against urease-producing bacteria, such as neomycin [42], paromomycin [44] or metronidazole [45], also reduce the production of intestinal ammonia and have proved to be of value. Vancomycin has also been used in patients with lactulose-resistant chronic encephalopathy [46]. The efficacy of neomycin is similar to that of lactulose [42]. However, a small percentage of this drug is absorbed from the gastrointestinal tract and may cause ototoxic and nephrotoxic effects, especially with continuous use over several months [47]. This drug should be used with particular caution by patients with renal insufficiency. The efficacy of metronidazole for... 

The early formulations of vancomycin, termed "Mississippi mud" because of its brownish color, were replete with impurities. Fever, hypotension and severe dose-limiting phlebitis were frequently seen in the patients first treated with vancomycin and were attributed to these impurities and pyrogens in these early preparations of vancomycin. In addition, the nephrotoxicity and ototoxicity first seen with vancomycin was also attributed to these impure formulations. Since its introduction, however, preparations of vancomycin have consistently improved achieving 92 to 95% purity since 1980 and the incidence of nephrotoxicity and ototoxicity has attenuated [172,174]. The incidence of nephrotoxicity associated with vancomycin is wide ranging with reports ranging from 0 to 44% in several prospective studies [174-178]. However, obtaining an accurate estimate of the incidence of nephrotoxicity from these studies is hindered by the variable purity of the vancomycin preparations administered, the different endpoints used to define nephrotoxicity, the presence of severe comorbid disease and the concomitant use of nephrotoxic medications in many of the study patients [174]. More recent reviews of the more contemporary vancomycin formulations place the overall incidence of nephrotoxicity of from 0 to 5% [183, 184]. 

Vancomycin (Vancocin) Prevents transfer of cell wall precurser from plasma membrane to cell wall. DOC Antibiotic associated colitis (C. d/ff/c//e). Staph and Strep infections which are resistant to penicillin or methacillin. Thrombophlebitis, ototoxicity, nephrotoxicity. When administered by rapid IV tachycardia, flushing, paresthesias, hypotension, severe nephrotoxicity... 

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