Vancomycin with aztreonam

Breed J, Teras J, Gardovskis J, Maritz FJ, Vaasna T, Ross DP, Gioud-Paquet M, Dartois N, Ellis-Grosse EJ, Loh E. (2005) Safety and efficacy of tigecycline in treatment of skin and skin structure infections Results of a double-blind phase 3 comparison study with vancomycin-aztreonam. Antimicrob Agents Chemother 49 4658 666. 

Aztreonam Incompatibility of aztreonam has been reported with metronidazole, nafcillin, and vancomycin.1... 

Results from animal studies indicate that while furosemide enhanced cephaloridine nephrotoxicity no increased renal toxicity was observed by combining of piperacillin with furosemide [142]. Latamoxef and flo-moxef may decrease nephrotoxicity of vancomycin by inhibiting its uptake into the kidney [146,147]. The results of a retrospective study including renal transplant patients indicate that aztreonam can be safely administered with cyclosporine [148]. Combination therapy with ampicillin/aztreonam in neonates showed a lower renal toxicity than in the group with concurrent administration of oxacillin/ amikacin [149]. 

Patients with delayed reactions to penicillin (skin rash) generally can receive cephalosporins. Patients with type I hypersensitivity reactions to penicillins (anaphylaxis) should not receive cephalosporins or carbapenems (alternatives include aztreonam, quinolones, sulfa drugs, or vancomycin based on type of coverage indicated). 

In patients who have had a severe reaction to a penicillin, it is inadvisable to administer a cephalosporin or a carbapenem such as meropenem. Aztreonam has no significant activity against gram-positive cocci, so the logical treatment in this case is vancomycin, often with an aminoglycoside for synergistic activity against enterococci. The answer is (E). 

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