Vancomycin-associated renal dysfunction: where are we now?

Pharmacotherapy. 2014 Dec;34(12):1259-68. doi: 10.1002/phar.1488. Epub 2014 Sep 15.


Vancomycin has been in clinical use for over 60 years, during which time renal toxicity has been well documented. Multiple risk factors and outcomes are associated with vancomycin-related nephrotoxicity. Risk factors include vancomycin exposure (trough levels 15 mg/L or higher, larger area under the curve, duration of therapy), host susceptibility to vancomycin (increased body weight, preexisting renal dysfunction, critical illness), and concurrent nephrotoxin therapy. Nephrotoxicity is associated with prolonged hospital stays, mortality, and the need for renal replacement therapy. To what degree vancomycin-associated nephrotoxicity exacerbates these adverse clinical outcomes remains unclear. This article reviews the current evidence on vancomycin-associated nephrotoxicity and explores future research directions with potential implications for improved patient safety.

Keywords: acute kidney injury; nephrotoxicity; vancomycin.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / pharmacokinetics
  • Humans
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / prevention & control
  • Vancomycin / adverse effects*
  • Vancomycin / pharmacokinetics


  • Anti-Bacterial Agents
  • Vancomycin