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.
Comparison
- Bind 30S → inhibit protein synthesis
- Inhibits cell-wall synthesis (glycopeptide)
- Serious gram-negative infection / sepsis
- MRSA / resistant gram-positive
- PO only for C. diff (not absorbed)
- IV or IM
- IV for systemic infection
- Infuse over ≥ 60 min
- Nephrotoxic — monitor renal function/BUN-Cr
- Avoid other nephrotoxins (loop diuretics)
- Nephrotoxic — monitor renal function/BUN-Cr
- Avoid other nephrotoxins (loop diuretics)
- ★Peak & trough — trough reflects toxicity
- Draw level before next dose
- ★Trough 10–20 mcg/mL (AUC-guided)
- Draw level before next dose
- Ototoxicity may be permanent
- Neuromuscular blockade (high dose)
- Nephrotoxic, esp. with high trough
- Ototoxicity (usually reversible)
- ↑ trough → nephro/ototoxicity; hold & redose
- ★Rapid infusion → flushing (infusion reaction)
- Renal impairment; other oto/nephrotoxins
- Renal impairment; other oto/nephrotoxins
- Report ringing, hearing loss, or dizziness
- Report ringing, hearing loss, or dizziness
Aminoglycosides
- Bind 30S → inhibit protein synthesis
Vancomycin
- Inhibits cell-wall synthesis (glycopeptide)
Aminoglycosides
- Serious gram-negative infection / sepsis
Vancomycin
- MRSA / resistant gram-positive
- PO only for C. diff (not absorbed)
Aminoglycosides
- IV or IM
Vancomycin
- IV for systemic infection
- Infuse over ≥ 60 min
Aminoglycosides
- Nephrotoxic — monitor renal function/BUN-Cr
- Avoid other nephrotoxins (loop diuretics)
Vancomycin
- Nephrotoxic — monitor renal function/BUN-Cr
- Avoid other nephrotoxins (loop diuretics)
Aminoglycosides
- ★Peak & trough — trough reflects toxicity
- Draw level before next dose
Vancomycin
- ★Trough 10–20 mcg/mL (AUC-guided)
- Draw level before next dose
Aminoglycosides
- Ototoxicity may be permanent
- Neuromuscular blockade (high dose)
Vancomycin
- Nephrotoxic, esp. with high trough
- Ototoxicity (usually reversible)
Aminoglycosides
- ↑ trough → nephro/ototoxicity; hold & redose
Vancomycin
- ★Rapid infusion → flushing (infusion reaction)
Aminoglycosides
- Renal impairment; other oto/nephrotoxins
Vancomycin
- Renal impairment; other oto/nephrotoxins
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.
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