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Higher doses of vancomycin in children 'risk kidney damage'

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Children given high-dose intravenous infusions of the antibiotic vancomycin for drug-resistant bacterial infections face an increased risk for kidney damage, US researchers have warned.

The findings, published in the journal Annals of Pharmacotherapy, highlight the importance of prescribing the antibiotic cautiously, the study authors said.

“What we really need are new drugs that achieve the same therapeutic effect without taking a toll on the kidneys and other organs”

Carlton Lee

The researchers, from Johns Hopkins Children’s Center in Baltimore, acknowledged that vancomycin had been used safely for decades, but noted that the spread of drug-resistant bacteria, such as MRSA, had prompted treatment with higher doses of the drug.

The study, based on analysis of patient records of 175 children treated with vancomycin between 2009 and 2010, found that 14% developed kidney damage.

The higher the dose, the greater the risk, with each 5mg per kg increase boosting the risk of kidney failure by 16%. For example, a 20kg (44 pound) child receiving 1,600mg of vancomycin per day has a 16% higher risk for kidney damage than a child of the same age and weight receiving 1,200mg of the drug daily.

The average daily dose among children who developed kidney damage was 10mg per kg higher than the average daily dose among kids who did not develop kidney damage.

Other factors affecting risk included prolonged therapy – each additional day of treatment increased risk by 11% – and simultaneous use of other drugs that can tax the kidneys, the researchers said.

Children who received more than one such medication showed five times higher risk for kidney damage. The average length of treatment with vancomycin was eight days among children who suffered kidney injury, compared with four days among those who did not.

As a result, the researchers said vancomycin therapy should include careful and frequent monitoring of kidney function in those receiving high doses.

However, they emphasized that the 30-year-old antibiotic could be a lifesaver for many patients with serious bacterial disease and that kidney damage is generally reversible when treatment stops.

“Our results bear out the difficult balancing act between ensuring the dose is high enough to successfully treat these serious and, at times, life-threatening infections against the small but real risk for kidney damage,” said study senior investigator Carlton Lee, a paediatric clinical pharmacist and associate professor of paediatrics.

“Ultimately, what we really need are new drugs that achieve the same therapeutic effect without taking a toll on the kidneys and other organs,” he added.

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