Increasing Evidence of the Nephrotoxicity of Piperacillin/Tazobactam and Vancomycin Combination Therapy-What Is the Clinician to Do?

Increasing Evidence of the Nephrotoxicity of Piperacillin/Tazobactam and Vancomycin Combination Therapy-What Is the Clinician to Do?

Watkins Richard R; Deresinski Stan

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2017

2017-11

Early administration of appropriate empiric antibiotics is essential for achieving the best possible outcomes in sepsis. Yet the choice of antibiotic therapy has become more challenging due to recent reports of nephrotoxicity with the combination of vancomycin and piperacillin/tazobactam, the "workhorse" regimen at many institutions. In this article we assess the evidence for nephrotoxicity and its possible mechanisms, provide recommendations for risk mitigation, address the advantages and disadvantages of alternative antibiotic choices, and suggest areas for future research.

Anti-Bacterial Agents/administration & dosage/*adverse effects/therapeutic use/*toxicity; Combination/*adverse effects; Combined Modality Therapy/*adverse effects; Drug Therapy; Humans; Kidney Diseases/*chemically induced; Kidney/*drug effects/pathology; nephrotoxicity; Penicillanic Acid/administration & dosage/adverse effects/analogs & derivatives/therapeutic use/toxicity; Piperacillin; Piperacillin/administration & dosage/adverse effects/therapeutic use/toxicity; piperacillin/tazobactam; Sepsis; Sepsis/drug therapy; Tazobactam Drug Combination; vancomycin; Vancomycin/administration & dosage/adverse effects/therapeutic use/toxicity

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

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