Invited Commentary

Commentary on Incidence and Predictors of Vancomycin-Associated Nephrotoxicity

Authors: P. Brandon Bookstaver, PharmD, BCPS (AQ-ID), Julie Ann Justo, PharmD, MS


Vancomycin dosing practices to target higher recommended trough concentrations of 15 mg to 20 mg/mL for invasive methicillin-resistant Staphylococcus aureus infections has resulted in clinical reports of increased incidence of nephrotoxicity.1 In this issue of the Southern Medical Journal, Kheir and colleagues show that the patients in this large study cohort had a mean initial trough of 11.6 µg/mL, expectedly lower than the targeted concentrations of 15 to 20 mg/mL, given the relatively conservative dosing of approximately 25 mg/kg (1000 mg intravenously every 12 hours).2 Despite the noted dosing strategy, vancomycin-associated nephrotoxicity (VAN) was reported in 26.6% of patients, comparable to published estimates of 5% to 43% in similar populations.1 The definition of VAN in this study, an increase of serum creatinine by 50% or 0.5 mg/dL (44.2 mmol/L) for two consecutive values, is consistent with that used in the majority of previous studies.1

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