Drug General Information (ID: DDIYK5LXJQ)
Drug Name			Piperacillin		Drug Info		Vancomycin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antibiotics				Antiinfective Agents
Structure

Mechanism of Piperacillin-Vancomycin Interaction (Severity Level: Major)
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Piperacillin				Vancomycin
Mechanism		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 1
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Piperacillin and Vancomycin

Recommended Action
Management		Caution is advised when vancomycin is used concomitantly with other nephrotoxic drugs such as piperacillin. Clinical and laboratory monitoring of renal function is recommended.

References
1	Burgess LD, Drew RH "Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam." Pharmacotherapy 34 (2014): 670-6. [PMID: 24855041]
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Gomes DM, Smotherman C, Birch A, et. al "Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime." Pharmacotherapy 34 (2014): 662-9. [PMID: 24753221]
5	Karino S, Kaye KS, Navalkele B, et.al "Epidemiology of acute kidney injury in critically ill patients receiving concomitant vancomycin and piperacillin/tazobactam: Opportunities for antimicrobial stewardship." Antimicrob Agents Chemother pii (2016): Epub. [PMID: 27067325]
6	Kim T, Kandiah S, Patel, M, et.al "Risk factors for kidney injury during vancomycin and piperacillin/tazobactam administration, including increased odds of injury with combination therapy." BMC Res Notes 8 (2015): 579. [PMID: 26476979]
7	Meaney CJ, Hynicka LM, Tsoukleris MG "Vancomycin-associated nephrotoxicity in adult medicine patients: incidence, outcomes, and risk factors." Pharmacotherapy 34 (2014): 653-61. [PMID: 24700598]
8	Peyko V, Smalley S, Cohen H "Prospective comparison of acute kidney injury during treatment with the combination of piperacillin-tazobactam and vancomycin versus the combination of cefepime or meropenem and vancomycin." J Pharm Pract pii (2016): Epub. [PMID: 26912532]
9	Reed EE, Johnston J, Severing J, Stevenson KB, Deutscher M "Nephrotoxicity risk factors and intravenous vancomycin dosing in the immediate postoperative period following antibiotic-impregnated cement spacer replacement." Ann Pharmacother 48 (2014): 962-9. [PMID: 24823910]
10	Hammond DA, Smith MN, Painter JT, Meena NK, Lusardi K "Comparative incidence of acute kidney injury in critically ill patients receiving vancomycin with concomitant piperacillin-tazobactam or cefepime: A restrospective cohort study." Pharmacotherapy 0 (2016): Epub. [PMID: 26952639]
11	Moenster RP, Linneman TW, Finnegan PM, Hand S, Thomas Z, McDonald JR "Acute renal failure associated with vancomycin and ?-lactams for the treatment of osteomyelitis in diabetics: piperacillin-tazobactam as compared with cefepime." Clin Microbiol Infect 2013 (2014): O384-9. [PMID: 24118354]