Filippone E J, Kraft W K, Farber J L
Department of Medicine, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Division of Nephrology, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Clin Pharmacol Ther. 2017 Sep;102(3):459-469. doi: 10.1002/cpt.726. Epub 2017 Jun 5.
Vancomycin use is often associated with nephrotoxicity. It remains uncertain, however, to what extent vancomycin is directly responsible, as numerous potential risk factors for acute kidney injury frequently coexist. Herein, we critically examine available data in adult patients pertinent to this question. We review the pharmacokinetics/pharmacodynamics of vancomycin metabolism. Efficacy and safety data are discussed. The pathophysiology of vancomycin nephrotoxicity is considered. Risk factors for nephrotoxicity are enumerated, including the potential synergistic nephrotoxicity of vancomycin and piperacillin-tazobactam. Suggestions for clinical practice and future research are given.
使用万古霉素常与肾毒性相关。然而，由于急性肾损伤的众多潜在风险因素经常同时存在，万古霉素在多大程度上直接导致肾毒性仍不确定。在此，我们严格审查了成年患者中与该问题相关的现有数据。我们回顾了万古霉素代谢的药代动力学/药效学。讨论了疗效和安全性数据。考虑了万古霉素肾毒性的病理生理学。列举了肾毒性的风险因素，包括万古霉素与哌拉西林-他唑巴坦潜在的协同肾毒性。给出了临床实践和未来研究的建议。
