From the Guidelines
Vancomycin can cause an increase in creatinine levels, and it is essential to monitor both creatinine and Blood Urea Nitrogen (BUN) levels during therapy. Vancomycin-associated nephrotoxicity typically affects both markers of kidney function, and this antibiotic can cause acute kidney injury through multiple mechanisms, including direct tubular toxicity and immune-mediated injury, particularly when administered at high doses, in combination with other nephrotoxic agents, or in patients with pre-existing kidney disease 1. The risk increases with higher trough concentrations (especially >20 mg/L), prolonged therapy (>7 days), and in elderly patients.
Key Considerations
- Monitoring both creatinine and BUN levels is recommended, typically at baseline and at least twice weekly during therapy 1.
- If kidney function deteriorates, dose adjustment or alternative antibiotic therapy may be necessary.
- Maintaining adequate hydration and avoiding concurrent nephrotoxic medications when possible can help reduce the risk of kidney injury during vancomycin treatment.
Dosage and Administration
- Vancomycin doses of 15–20 mg/kg/day every 8–12 h are recommended for adult patients on the basis of actual body weight and are adjusted for the patient’s estimated creatinine clearance, not to exceed 2 g per dose 1.
- Trough vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction (including those receiving dialysis), or have fluctuating volumes of distribution 1.
Patient Care
- It is crucial to prioritize the monitoring of both creatinine and BUN levels to minimize the risk of vancomycin-induced nephrotoxicity, as the evidence suggests that vancomycin can cause increases in both markers of kidney function 1.
From the FDA Drug Label
Laboratory Abnormalities: Elevated blood urea nitrogen, elevated serum creatinine The FDA drug label does mention that vancomycin can cause an increase in serum creatinine levels, which is an indicator of kidney function. However, it also mentions that vancomycin can cause an increase in blood urea nitrogen (BUN) levels. Therefore, vancomycin can cause an increase in both creatinine and BUN levels, not just creatinine. 2
From the Research
Vancomycin's Effect on Renal Function
- Vancomycin has been associated with nephrotoxicity, which can lead to an increase in creatinine levels 3, 4, 5, 6, 7.
- The evidence suggests that vancomycin can cause an increase in creatinine levels, but its effect on Blood Urea Nitrogen (BUN) levels is less clear 3, 6.
- A study published in 2023 found that vancomycin treatment was associated with significant increases in serum creatinine levels, but not BUN levels 3.
- Another study published in 2013 found that vancomycin was minimally nephrotoxic and had a similar nephrotoxic profile to linezolid when appropriate dosing was used 4.
- A case study published in 2007 highlighted the importance of monitoring vancomycin levels and renal function in patients with HIV and low muscle mass, as they may be at increased risk of nephrotoxicity 5.
- A study published in 1989 found that vancomycin administration was associated with a small increase in creatinine levels, but not BUN levels 6.
- A more recent study published in 2019 found that high-dose vancomycin loading doses did not increase nephrotoxicity compared to lower doses in patients with severe renal dysfunction 7.
Predictors of Nephrotoxicity
- Increasing age, body weight, vancomycin dose and trough levels, and duration of treatment have been identified as predictors of nephrotoxicity 3, 4, 7.
- Critically ill patients and those with certain types of infections may also be at increased risk of nephrotoxicity 3, 4.
- The use of vancomycin in patients with pre-existing renal impairment may also increase the risk of nephrotoxicity 5, 7.