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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- Bind 30S then inhibit protein synthesis
- Glycopeptide: blocks cell-wall synthesis
- Serious gram-negative infection / sepsis
- MRSA / resistant gram-positive
- PO only for C. diff (not absorbed)
- IV or IM
- IV for systemic use, never IM
- Infuse over ≥ 60 min
- Nephrotoxic — monitor BUN/creatinine
- Avoid other nephrotoxins (e.g., loops)
- Nephrotoxic — monitor BUN/creatinine
- Avoid other nephrotoxins (e.g., loops)
- ★Peak & trough — trough reflects toxicity
- Draw level before next dose
- ★AUC 400–600 or trough 10–20
- Draw level before next dose
- Ototoxicity may be permanent
- Neuromuscular blockade (high dose)
- Thrombophlebitis at IV site
- Ototoxicity (usually reversible)
- ↑ trough then nephrotoxicity
- ★Rapid infusion: flushing, rash, ↓ BP
- ↑ trough then nephrotoxicity
- Renal impairment: adjust dose
- Other oto/nephrotoxic drugs
- Myasthenia gravis (NM blockade)
- Renal impairment: adjust dose
- Other oto/nephrotoxic drugs
- Report tinnitus, hearing loss, dizziness
- Report tinnitus, hearing loss, dizziness
Aminoglycosides
- Bind 30S then inhibit protein synthesis
Vancomycin
- Glycopeptide: blocks cell-wall synthesis
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 use, never IM
- Infuse over ≥ 60 min
Aminoglycosides
- Nephrotoxic — monitor BUN/creatinine
- Avoid other nephrotoxins (e.g., loops)
Vancomycin
- Nephrotoxic — monitor BUN/creatinine
- Avoid other nephrotoxins (e.g., loops)
Aminoglycosides
- ★Peak & trough — trough reflects toxicity
- Draw level before next dose
Vancomycin
- ★AUC 400–600 or trough 10–20
- Draw level before next dose
Aminoglycosides
- Ototoxicity may be permanent
- Neuromuscular blockade (high dose)
Vancomycin
- Thrombophlebitis at IV site
- Ototoxicity (usually reversible)
Aminoglycosides
- ↑ trough then nephrotoxicity
Vancomycin
- ★Rapid infusion: flushing, rash, ↓ BP
- ↑ trough then nephrotoxicity
Aminoglycosides
- Renal impairment: adjust dose
- Other oto/nephrotoxic drugs
- Myasthenia gravis (NM blockade)
Vancomycin
- Renal impairment: adjust dose
- Other oto/nephrotoxic drugs
Aminoglycosides
- Report tinnitus, hearing loss, dizziness
Vancomycin
- Report tinnitus, hearing loss, dizziness
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Red Man = vancomycin too fast, slow the rate. Ringing ears = aminoglycoside, check the trough.
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Go further
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