Vancomycin and the Kidney

V ANCOMYCIN, a glycopeptide antibiotic, obtained as a fermentation product from Nocardia orienta lis (formerly Streptomyces orientalis), was first developed in the mid-1950s. 1.2 Some closely related biologic products are copurified with the predominant active compound designated vancomycin B. Initially, vancomycin had a unique role in the treatment of penicillin-resistant grampositive infections. Subsequently, vancomycin use declined following the introduction of antistaphylococcal semisynthetic penicillins and cephalosporins. However, there recently has been a resurgence in usage \.3.4 due to (l) the increased frequency of infections due to methicillin-resistant staphylococci; (2) the increased recognition of the importance of Staphylococcus epidermidis infections, particularly in patients with shunts, catheters, and prosthetic implants; (3) recognition of Clostridium difficile as the causative agent of pseudomembranous colitis; and (4) the favorable pharmacokinetics of vancomycin in patients undergoing renal dialysis. Vancomycin is of particular interest to nephrologists and to other physicians who care for patients with renal diseases. Although this antibiotic is widely believed to be a potential cause of nephrotoxicity, it is frequently used in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD).5 This review will analyze available information concerning vancomycin and the kidney. The clinical implications of vancomycin pharmacokinetics in patients with varying degrees of renal insufficiency and the use of vancomycin in dialysis patients also will be discussed.