Open Access Ragab et al., 2:2 http://dx.doi.org/10.4172/scientificreports.622 Research Article Open Access Open Access Scientific Reports Scientific Reports Open Access Volume 2 • Issue 2 • 2013 Keywords: Vancomycin therapy; Renal toxicity; Vancomycin nephrotoxicity; Pediatric toxicity Introduction Vancomycin is a bactericidal; glycopeptide antibiotic, widely used in children for treating methicillin-resistant Staphylococcus aureus (MRSA) infections [1]. In fact, vancomycin trough serum concentrations between 10 and 15 mg/L have been recommended for serious infections caused by MRSA (including endocarditis, osteomyelitis, meningitis and pneumonia), and strains with elevated vancomycin MICs of 2 mg/L [2,3]. Although this consensus statement excluded recommendations for children, aggressive vancomycin dosing regimens are nonetheless being used with pediatric patients. Tis dosing may increase the incidence of nephrotoxicity in children. Vancomycin-associated renal toxicity has been a point of controversy since 1958, when Geraci et al. [4] published the frst case series, linking the two. Since then, several studies have reported an association between vancomycin serum trough concentrations and renal toxicity [5-7]. Although vancomycin has been associated with nephrotoxicity, causality has not been frmly established. Data in adult patients indicate that higher vancomycin doses (or higher serum trough concentrations) are associated with increased nephrotoxicity [8-10]. Nephrotoxicity data associated with higher vancomycin trough attainment through aggressive dosing in the pediatric population is lacking, although rates might be higher with increased troughs, as evident in adults. However, the defnition of renal toxicity as well as the patient population and disease severity, has varied among these studies. Terefore, we performed a retrospective observational clinical study, with the main goal of determining the overall rate and predisposing factors associated with development of nephrotoxicity in children receiving vancomycin, including those achieving high average vancomycin serum trough concentrations of ≥ 10 µg/ml. *Corresponding author: Ahmed Refat Ragab, Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Egypt, E-mail: ahmedrefat1973@yahoo.com Received January 31, 2013; Published February 22, 2013 Citation: Ragab AR, Al-Mazroua MK, Al-Harony MA (2013) Incidence and Predisposing Factors of Vancomycin-Induced Nephrotoxicity in Children. 2: 622 doi:10.4172/scientifcreports.622 Copyright: © 2013 Ragab AR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objective: To determine the pattern of vancomycin-associated nephrotoxicity in children, and to examine potential predisposing factors for nephrotoxicity, including average serum trough concentrations >10 mg/L. Subjects and methods: Patients ≥ week old to ≤ 15 years with normal baseline serum creatinine values who received vancomycin for ≥ 48 hours between October 2010 and September, 2012 were retrospectively evaluated. Nephrotoxicity was defned as a serum creatinine increase of ≥ 0.5 mg/dL or ≥ 50% baseline increase over two days. Patients with average serum trough concentrations ≥ 10 mg/L were compared with a lower trough group. Results: Renal toxicity occurred in 72 (27.2%) of the studied pediatric 265 cases. High trough vancomycin levels>10 µg/dl were presented in 59 pediatric patients suffering from nephrotoxicity. Cases admitted to the ICU, to whom aminoglycoside medication was administered concurrently with vancomycin medication, showed a signifcant, high renal toxicity incidence (p value 0.03 and 0.05, respectively). Conclusions: Renal function and continuous monitoring of vancomycin trough level for children receiving vancomycin therapy and admitted to the ICU, and given other aminoglycoside medications, is mandatory. Incidence and Predisposing Factors of Vancomycin-Induced Nephrotoxicity in Children Ahmed Refat Ragab 1,2 *, Maha Khalid Al-Mazroua 2 and Mona Ahmed Al-Harony 1 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Egypt 2 Dammam Regional Poison Control Center, Eastern Region, KSA Subjects and Methods Study setting Tis study was conducted at Dammam Maternal and Child Hospital (DMCH), a community-based, secondary care hospital. All pediatric patients receiving vancomycin are routinely monitored according to guidelines by toxicologists who perform pharmacokinetic analyses to assess toxicity and goal trough attainment. All Dammam Poison Control Center (DPCC) clinical toxicologists are trained, and have undergone internal competency training and testing in making pharmacokinetic calculations, both by manual calculation and with the use of an institution-based computer kinetic program. Steady-state serum trough concentrations are generally obtained and baseline and periodic serum creatinine (SCr) values are monitored in all patients. Inclusion and exclusion criteria In our retrospective study, eligible patients were one week (and not born prematurely before 37 weeks gestational age) to 15 years of age; had received vancomycin for at least 48 hours between November 2010 and October 2012; and had normal baseline SCr values (defned as ≤ 0.6 mg/dL for patients ≤ 1 month old and ≤ 0.9 mg/dL for those > 1 month old). Te defnition of normal renal function was applied to the start of vancomycin therapy only. Patients were required to have had one or more serum vancomycin concentrations and repeat SCr values. Premature neonates and infants cared for in the neonatal intensive care