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Aminoglycoside Nephrotoxicity — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipAminoglycoside NephrotoxicitySCE Infectious Diseases

A hospital pharmacist reviews the drug chart of a patient receiving IV Gentamicin and IV Vancomycin concurrently for prosthetic valve endocarditis. The patient's creatinine has risen from 85 to 180 µmol/L over 5 days. What is the most likely cause?

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Correct answer: B — Synergistic nephrotoxicity from concurrent aminoglycoside and glycopeptide use

Concurrent aminoglycoside (Gentamicin) and glycopeptide (Vancomycin) use has well-documented synergistic nephrotoxicity. Both drugs are nephrotoxic individually; together the risk is significantly amplified. This is a common clinical scenario in endocarditis treatment. Management includes: checking drug levels (Gentamicin trough <1 mg/L; Vancomycin trough 15–20 mg/L), optimising hydration, and potentially shortening or stopping Gentamicin if clinically appropriate. Renal function monitoring should be at least every 48 hours with dual nephrotoxic agents.

Reference: BNF 2024 – Gentamicin/Vancomycin; BSAC 2023 – TDM guidelines