Introduction:
Vancomycin is a type of antibiotic used to treat bacterial infections. It was first discovered in 1953 and has since then become an important tool in the fight against infections caused by certain types of bacteria. It belongs to the group of glycopeptide antibiotics. In 1957, Dr. E.C Kornfield, an organic chemist working with Eli Lilly, discovered Vancomycin while conducting research in the dense forests of Borneo. The source of origin of this antibiotic is primarily Streptococcus orientalis. Vancomycin is particularly effective against gram-positive bacteria, including Staphylococcus aureus and Streptococcus pneumoniae, which are often resistant to other types of antibiotics. Vancomycin functions by eliminating bacteria residing in the gut. Administering the drug orally does not result in the eradication of bacteria or the resolution of infections located in other regions of the body.
What Are the Uses of Vancomycin?
The uses of Vancomycin, as approved by the Food and Drug Administration (FDA), include the following:
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Methicillin-resistant Staphylococcus aureus (MRSA) infections and Methicillin-susceptible Staphylococcus aureus (MSSA) infections.
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Streptococci and enterococci infections.
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Gastrointestinal infections, such as Clostridium difficile colitis, are a severe form of diarrhea caused by the bacteria Clostridium difficile.
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Treating bone and joint infections, skin and soft tissue-related infections, and septicemia (a potentially life-threatening bloodstream infection).
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Prevent bacterial endocarditis associated with Enterococcal, Diphtheroid, Staphylococcal, and Streptococcal species in patients who are at high risk of developing the condition, such as those with artificial heart valves.
Other off-label uses of Vancomycin include:
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Vancomycin can be used prophylactically in surgical procedures to prevent infections caused by gram-positive bacteria.
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Catheter-related infections, which occur due to the use of catheters.
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Necrotizing skin and soft tissue infection.
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Bacterial meningitis (inflammation of the protective membranes surrounding the brain and spinal cord).
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Bacterial endophthalmitis (a severe infection of the interior of the eye).
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Peritonitis (a medical condition that arises due to the inflammation of the peritoneum, which is the delicate tissue that lines the abdominal cavity). Peritoneum covers most of the abdominal organs.
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Prosthetic joint infection is caused by the invasion of bacteria into the artificial joint. It is a serious complication of joint replacement surgery.
What Is Vancomycin Toxicity?
Vancomycin toxicity refers to the harmful effects that can occur when the antibiotic Vancomycin is misused or at high doses. Vancomycin is generally safe when used properly, but as with any other medication, there is a possibility of experiencing side effects. One of the major causes of Vancomycin toxicity is high doses of the drug. When given at higher-than-recommended doses, this drug can accumulate in the body and cause damage to the kidneys, ears, and other organs. Prolonged treatment with this medication also increases the chance of toxicity. The longer a patient is treated with Vancomycin, the greater the risk of toxicity.
Who Is at Risk of Getting Vancomycin Toxicity?
The risks of toxicity are higher in the following cases:
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Kidney Disease: Patients with preexisting kidney disease are at increased risk for Vancomycin toxicity, as the drug is primarily eliminated from the body through the kidneys. Improper functioning of kidneys causes the build-up of this medication within the body and results in damage to the kidneys themselves, as well as other organs.
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Older Age: As age progresses risk of developing toxicity also increases. Older people's kidneys may not function as well as younger adults. In addition, older adults may be more likely to have other health conditions that increase their risk of toxicity.
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Patients on Other Medications: Some medications can increase the risk of toxicity when taken in combination with this drug. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen can elevate the risk of kidney damage when taken with Vancomycin.
What Are the Health Effects of Vancomycin Toxicity?
The symptoms of Vancomycin toxicity include:
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Kidney Damage: Vancomycin toxicity can cause damage to the kidneys, which may result in symptoms such as decreased urine output, fluid retention, swelling in the legs or feet, and fatigue.
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Hearing Loss: Vancomycin can cause damage to the auditory system, resulting in symptoms such as impaired hearing, tinnitus characterized by a ringing or buzzing sound in the ears, and dizziness.
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Skin Rash: Some patients may develop a skin rash or hives as a result of Vancomycin toxicity.
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Red Man Syndrome: Red Man syndrome is a type of allergic reaction that can occur in some patients while taking this medication. Symptoms may include flushing of the face, neck, and upper body, as well as itching and hives.
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Gastrointestinal Symptoms: Nausea, vomiting, and diarrhea may be present.
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Neurological Symptoms: In rare cases, this toxicity can cause neurological symptoms such as confusion, seizures, and hallucinations.
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Low Blood Pressure: Vancomycin can cause a drop in blood pressure, which may result in symptoms such as lightheadedness, dizziness, and fainting.
How Can Vancomycin Toxicity Be Diagnosed?
Vancomycin toxicity can be diagnosed with the help of the following ways:
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Medical History: The healthcare professional will inquire about any preexisting conditions, medications they are currently taking, and previous exposure to Vancomycin. This information can help to identify potential risk factors for toxicity.
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Physical Examination: The healthcare professional will perform a physical evaluation to assess for any signs of toxicity, such as skin rash, hearing loss, and kidney damage.
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Laboratory Tests: Healthcare professionals may conduct blood and urine tests to assess kidney function and look for signs of this toxicity. The tests that are commonly performed for this purpose may comprise a blood chemistry panel, complete blood count (CBC), and urinalysis.
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Imaging Tests: In some cases, imaging tests such as a CT (computed tomography) scan or ultrasound may be ordered to assess for kidney damage.
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Vancomycin Trough Levels: Vancomycin levels in the blood can be measured to assess toxicity. Trough levels, which are drawn just before the next dose of Vancomycin, are the most commonly used measure for detecting Vancomycin levels.
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Audiology Testing: Patients who are taking Vancomycin for a long time may be referred for audiology testing to assess for hearing loss.
What Is the Treatment for Vancomycin Toxicity?
Vancomycin toxicity can be treated by following steps:
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Stopping Vancomycin: The healthcare professional may adjust the patient's dose or discontinue the medication if they suspect Vancomycin toxicity. This may involve switching to a different antibiotic that is less likely to cause toxicity.
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Supportive Treatment: This treatment may be necessary to manage symptoms of Vancomycin toxicity. Patients with kidney damage may need intravenous fluids to maintain hydration, while patients with hearing loss may benefit from hearing aids.
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Monitoring: Patients with Vancomycin toxicity may need close monitoring to assess for complications and ensure that their symptoms are improving. This may comprise regular urine and blood tests to assess kidney function, audiology testing to assess hearing loss, and imaging studies to assess organ damage.
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Symptomatic Treatment: Symptomatic treatment may be necessary to manage specific symptoms associated with toxicity. Patients with skin rash may benefit from topical creams or oral Antihistamines, while patients with low blood pressure may benefit from intravenous fluids and medications to raise blood pressure.
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Renal Replacement Therapy: In severe cases of Vancomycin toxicity, renal replacement therapy may be necessary. This involves using a machine to filter the blood and remove waste products when the kidneys are not functioning properly.
Conclusion:
Vancomycin toxicity is not very common, but it can occur in some patients who are taking the medication. Patients taking Vancomycin should be closely monitored for signs of toxicity, and the drug should be used as per the doctor's instructions and only when necessary. If Vancomycin toxicity is suspected by doctors, they may adjust the dose or switch to a different medication. Most cases of this toxicity can be reversed with appropriate treatment.
