Alternatives to Vancomycin & Pip/Tazo Combination Therapy

Megan Luther, PharmD, Advanced Health Services research fellow, Providence Veterans Affairs Medical Center, University of Rhode Island, College of Pharmacy, discusses alternative therapies to the acute kidney injury-causing combination of vancomycin piperacillin/tazobactam.

Interview Transcript (slightly modified for readability)

“Our study found an increased odds of acute kidney injury with the combination of vancomycin [piperacillin/tazobactam], and it was across the board, so against vancomycin alone, against pip/tazo alone and against vancomycin with cefepime or meropenem. Pretty consistently across the board, about a three-fold increase in the odds of acute kidney injury [was observed when patients were treated with these] combination[s].

A lot of patients receive that combination therapy. Even though the acute kidney injury is usually reversible (it occurs within the first 4-7 days of therapy, generally­— at least in these studies that we’ve included) this is [still] an opportunity for stewardship to come in and limit that duration of therapy. [We’d] be able to, hopefully, decrease the acute kidney injury incidence that we’re seeing if we can narrow therapy before that 4- 7-day window.

If we can get patients off of the combination of vancomycin and pip/tazo, [which is a] very broad spectrum empiric therapy that we use for coverage before we know what that particular infection is [or] what’s causing that infection, if we can get either rapid diagnostic tests so we can actually identify what bug that is causing that infection, and then what therapy would be ideal for that infection and narrow that therapy down, get them off vanco and pip/tazo, either to vancomycin itself if it’s MRSA, or [get them on] a different antibiotic, not that combination, [we would be able to] decrease the chances of acute kidney injury.”