side by side comparison

Nephrotoxic/Ototoxic Drug Comparison: Aminoglycosides vs Vancomycin — Peak/Trough, Monitoring, Red Flags

Both aminoglycosides and vancomycin destroy kidneys and hearing, and both require trough monitoring — but the trough ranges differ, the dominant toxicity differs, and only one causes Red Man Syndrome. Picking the wrong monitoring parameter or misidentifying the adverse reaction costs you the question and, clinically, the patient's hearing or renal function.

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Comparison

Side-by-side2 compared
Dimension
Aminoglycosides
Vancomycin
Class & mechanism
  • Bind 30S then inhibit protein synthesis
  • Inhibits cell-wall synthesis (glycopeptide)
Indications
  • Serious gram-negative infection / sepsis
  • MRSA / resistant gram-positive
  • PO only for C. diff (not absorbed)
Route
  • IV or IM
  • IV for systemic infection
  • Infuse over ≥ 60 min
Key assessment
  • Nephrotoxic — monitor renal function/BUN-Cr
  • Avoid other nephrotoxins (loop diuretics)
  • Nephrotoxic — monitor renal function/BUN-Cr
  • Avoid other nephrotoxins (loop diuretics)
Monitoring labs
  • ★Peak & trough — trough reflects toxicity
  • Draw level before next dose
  • ★Trough 10–20 mcg/mL (AUC-guided)
  • Draw level before next dose
Adverse effects
  • Ototoxicity may be permanent
  • Neuromuscular blockade (high dose)
  • Nephrotoxic, esp. with high trough
  • Ototoxicity (usually reversible)
Toxicity & reactions
  • ↑ trough then nephro/ototoxicity
  • hold & redose
  • ★Rapid infusion then flushing (infusion reaction)
Contraindications & interactions
  • Renal impairment
  • other oto/nephrotoxins
  • Renal impairment
  • other oto/nephrotoxins
Patient teaching
  • Report ringing, hearing loss, or dizziness
  • Report ringing, hearing loss, or dizziness
Class & mechanism

Aminoglycosides

  • Bind 30S then inhibit protein synthesis

Vancomycin

  • Inhibits cell-wall synthesis (glycopeptide)
Indications

Aminoglycosides

  • Serious gram-negative infection / sepsis

Vancomycin

  • MRSA / resistant gram-positive
  • PO only for C. diff (not absorbed)
Route

Aminoglycosides

  • IV or IM

Vancomycin

  • IV for systemic infection
  • Infuse over ≥ 60 min
Key assessment

Aminoglycosides

  • Nephrotoxic — monitor renal function/BUN-Cr
  • Avoid other nephrotoxins (loop diuretics)

Vancomycin

  • Nephrotoxic — monitor renal function/BUN-Cr
  • Avoid other nephrotoxins (loop diuretics)
Monitoring labs

Aminoglycosides

  • ★Peak & trough — trough reflects toxicity
  • Draw level before next dose

Vancomycin

  • ★Trough 10–20 mcg/mL (AUC-guided)
  • Draw level before next dose
Adverse effects

Aminoglycosides

  • Ototoxicity may be permanent
  • Neuromuscular blockade (high dose)

Vancomycin

  • Nephrotoxic, esp. with high trough
  • Ototoxicity (usually reversible)
Toxicity & reactions

Aminoglycosides

  • ↑ trough then nephro/ototoxicity
  • hold & redose

Vancomycin

  • ★Rapid infusion then flushing (infusion reaction)
Contraindications & interactions

Aminoglycosides

  • Renal impairment
  • other oto/nephrotoxins

Vancomycin

  • Renal impairment
  • other oto/nephrotoxins
Patient teaching

Aminoglycosides

  • Report ringing, hearing loss, or dizziness

Vancomycin

  • Report ringing, hearing loss, or dizziness

★ marks the fact that sets a column apart.

Clinical Pearl

Red Man = vancomycin too fast, slow the rate. Ringing ears = aminoglycoside, check the trough.

Component Topics

AminoglycosidesVancomycin

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