Abstract
Early administration of appropriate empiric antibiotics is essential for achieving the best possible outcomes in sepsis. Yet the choice of antibiotic therapy has become more challenging due to recent reports of nephrotoxicity with the combination of vancomycin and piperacillin/tazobactam, the "workhorse" regimen at many institutions. In this article we assess the evidence for nephrotoxicity and its possible mechanisms, provide recommendations for risk mitigation, address the advantages and disadvantages of alternative antibiotic choices, and suggest areas for future research.
Keywords:
Sepsis; nephrotoxicity; piperacillin/tazobactam; vancomycin.
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
MeSH terms
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Anti-Bacterial Agents / administration & dosage
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Anti-Bacterial Agents / adverse effects*
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Anti-Bacterial Agents / therapeutic use
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Anti-Bacterial Agents / toxicity*
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Combined Modality Therapy / adverse effects*
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Drug Therapy, Combination / adverse effects*
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Humans
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Kidney / drug effects*
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Kidney / pathology
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Kidney Diseases / chemically induced*
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Penicillanic Acid / administration & dosage
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Penicillanic Acid / adverse effects
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Penicillanic Acid / analogs & derivatives
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Penicillanic Acid / therapeutic use
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Penicillanic Acid / toxicity
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Piperacillin / administration & dosage
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Piperacillin / adverse effects
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Piperacillin / therapeutic use
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Piperacillin / toxicity
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Piperacillin, Tazobactam Drug Combination
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Sepsis / drug therapy
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Vancomycin / administration & dosage
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Vancomycin / adverse effects
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Vancomycin / therapeutic use
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Vancomycin / toxicity
Substances
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Anti-Bacterial Agents
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Piperacillin, Tazobactam Drug Combination
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Vancomycin
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Penicillanic Acid
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Piperacillin