Aminoglycosides and vancomycin

Nephrotoxicity of vancomycin is often mild and reversible after withdrawal. It occurs in 6-17% of courses (59). Higher frequencies of nephrotoxicity were reported when vancomycin was used in combination with an aminoglycoside, which is consistent with toxicological data obtained in rats (60). Nevertheless, evidence of synergistic toxicity between vancomycin and aminoglycosides is controversial (2,31,59). Endotoxins seem to potentiate the nephrotoxic effect of vancomycin, at least in rats (61). 

Goetz MB, Sayers J, Nephrotoxicity of vancomycin and aminoglycoside therapy separately and in combination, J Antimicrob Chemother, 1993,32 325-34. 

Other cla.sses of therapeutically important compounds that have been. synthesized successfully by u.sing solid-pha.se combinatorial chemistry include carbohydrates and natural products. Polysaccharides ate important for various carbohydrate-protein interactions. Carbohydrate antibiotics, including vancomycin and aminoglycosides, have been the targets of combinatorial chemistry, as well as complex oligosaccharides like the one shown in Figure 3-9." A vari-... 

Oum BS, D Amico DJ, Wong KW. Intravitreal antibiotic therapy with vancomycin and aminoglycoside. An experimental study of combination and repetitive injections. Arch Ophthalmol 1989 107 1055-1060. 

Also avoid giving vancomycin if the patient has taken any aminoglycosides because they increase the potential for ototoxicity (ear) and nephrotoxicity (kidney). If the patient receives vancomycin and aminoglycosides, then you must closely monitor vancomycin serum levels to determine that it remains within the safe range. Dmg-drug interaction may occur if administering Vancomycin with ... 

Obtain serum drug levels for aminoglycosides and/or vancomycin and perform pharmacokinetic analysis. Adjust the dose, if needed, according to the parameters in Table 13-2. Obtain follow-up trough levels at weekly intervals or sooner if renal function is unstable. Follow serum creatinine levels if renal function is unstable. Hearing tests may be scheduled yearly or per patient preference. 

Drugs that may interact with vancomycin include aminoglycosides, anesthetics, neurotoxic/nephrotoxic agents, and nondepolarizing muscle relaxants. 

Benzylpenicillin is incompatible with rubber products and metal ions. Stability is affected by alcohols, surfactants, oxidizing and reducing agents, macrogols and other hydroxy compounds, glycerol, glycols, some paraffins and ointment bases, preservatives such as chlorocresol or thiomersal, blood and blood products, and antibacterials such as amphotericin, cephalosporins, and vancomycin. Injections of benzylpenicillins and aminoglycosides should be administered separately. 

Ceftazidime Ceftazidime is not compatible with aminoglycosides, vancomycin, and pentamidine visual incompatibilities or inactivation have been reported.3... 

VANCOMYCIN ANTIBIOTICS-AMINOGLYCOSIDES, COLISTIN, TEICOPLANIN t risk of nephrotoxicity and ototoxicity Additive effect Hearing and renal function should be carefully monitored... 

Combined use of vancomycin and an aminoglycoside can increase the risk of toxicity (188-190). 

Teicoplanin can be nephrotoxic, but less often than vancomycin (6). However, concomitant aminoglycoside therapy in some patients makes the contribution of the glycopeptide antibiotic difficult to assess. Renal toxicity was observed more often in patients receiving the combination of netilmicin plus vancomycin than in patients treated with netilmicin plus teicoplanin (35). Similar differences in nephrotoxicity between vancomycin and... 

Beta-lactam induced renal toxicity can results from their use in monotherapy or when used in combination with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, cyclosporine, furosemide, ifosfamide, vancomycin and nephrotoxic p-lactams. While the risk of nephrotoxic injury from monotherapy with p-lactams is relatively low, this risk is substantially increased when multiple drug combinations are required. 

A more widely used approach is to divide agents into those approved for unrestricted use and those for restricted use. Agents on the unrestricted list are appropriate for the majority of common clinical situations. The restricted list may include agents where microbiological sensitivity information is essential, such as for vancomycin and certain aminoglycosides. In addition, agents that are used infrequently but for specific indications, such as parenteral amphotericin B, are also restricted in use. Other compounds that may be expensive and... 

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