Relationship of Vancomycin Concentrations and Ototoxicity

Thomas E. Lackner, PharmD
Arch Intern Med. 1984;144(2):419. doi:10.1001/archinte.1984.00350140253045.
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To the Editor.  —Vancomycin hydrochloride is being prescribed with increasing frequency as a result of the proliferation of methicillin-resistant strains of Staphylococcus aureus and its recognized value in Staphylococcus epidermidis infections in patients with prosthetic devices.1,2 Ototoxicity from vancomycin can occur and is apparently a function of elevated serum concentrations.3 Despite a possibly reduced incidence with today's more purified formulation, reports of ototoxicity persist.4,5 In early case reports, eighth cranial nerve damage was only evident with serum vancomycin concentrations of 80 μg/mL or greater at one or more hours after infusion.3 In one case report, however, measured vancomycin concentrations at one hour after infusion never exceeded 50 μg/mL.5 This discrepancy might be explained by improper evaluation of vancomycin concentrations from an inappropriate sampling time, in conjunction with poorly defined ototoxic levels.Vancomycin pharmacokinetics can be described by a two-compartment pharmacokinetic model (Figure). The half-life of


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