Serum<unk>  levels may be monitored in an effort to reduce side effects, although the<unk> alue of such monitoring has been questioned. Peak and trough levels are usually monitored, and for research purposes, the area under the concentration curve is also sometimes used. Toxicity is best monitored by looking at trough<unk> alues. Common adverse drug reactions (≥1% of patients) associated with IV<unk>  include: local pain, which may be severe, and thrombophlebitis. Damage to the kidneys (nephrotoxicity) and to the hearing (ototoxicity) were side effects of the early impure<unk> ersions of<unk> , and these were prominent in the clinical trials conducted in the mid-1950s. Later trials using purer forms of<unk>  found nephrotoxicity is an infrequent adverse effect (0.1% to 1% of patients), but this is accentuated in the presence of aminoglycosides. Rare adverse effects (<0.1% of patients) include: anaphylaxis, toxic epidermal necrolysis, erythema multiforme, red man syndrome, superinfection, thrombocytopenia, neutropenia, leukopenia, tinnitus, dizziness and/or ototoxicity, and DRESS syndrome.<unk>  can induce platelet-reactive antibodies in the patient, leading to severe thrombocytopenia and bleeding with florid petechial hemorrhages, ecchymoses, and wet purpura.<unk>  has traditionally been considered a nephrotoxic and ototoxic drug, based on observations by early investigators of elevated serum levels in renally impaired patients who had experienced ototoxicity, and subsequently through case reports in the medical literature. However, as the use of<unk>  increased with the spread of MRSA beginning in the 1970s, the previously reported rates of toxicity were recognized as not being observed. This was attributed to the removal of the impurities present in the earlier formulation of the drug, although those impurities were not specifically tested for toxicity. Nephrotoxicity Subsequent reviews of accumulated case reports of<unk> -related nephrotoxicity found many of the patients had also received other known nephrotoxins, in particular, aminoglycosides. Most of the rest had other confounding factors, or insufficient data regarding the possibility of such, that prohibited the clear association of<unk>  with the observed kidney dysfunction. In 1994, the use of<unk>  monotherapy was clearly documented in only three of 82 available cases in the literature. Prospective and retrospective studies attempting to evaluate the incidence of<unk> -related nephrotoxicity have largely been methodologically flawed and have produced<unk> ariable results. The most methodologically sound investigations indicate the actual incidence of<unk> -induced nephrotoxicity is around 5% to 7%. To put this into context, similar rates of kidney dysfunction have been reported for cefamandole and benzylpenicillin, two reputedly non-nephrotoxic antibiotics. In addition, evidence to relate nephrotoxicity to<unk>  serum levels is inconsistent. Some studies have indicated an increased rate of nephrotoxicity when trough levels exceed 10 µg/ml, but others have not reproduced these results. Nephrotoxicity has also been observed with concentrations within the "therapeutic" range, as well. In essence, the reputation of<unk>  as a nephrotoxin is overstated, and it has not been demonstrated that maintaining<unk>  serum levels within certain ranges will prevent its nephrotoxic effects, when they do occur. Ototoxicity Attempts to establish rates of<unk> -induced ototoxicity are even more difficult due to the scarcity of quality evidence. The current consensus is that clearly related cases of<unk>  ototoxicity are rare. The association between<unk>  serum levels and ototoxicity is also uncertain. While cases of ototoxicity have been reported in patients whose<unk>  serum level exceeded 80 µg/ml, cases have been reported in patients with therapeutic levels, as well. Thus, whether therapeutic drug monitoring of<unk>  for the purpose of maintaining "therapeutic" levels will prevent ototoxicity also remains unproven. Interactions with other nephrotoxins Another area of controversy and uncertainty concerns the question of whether, and if so, to what extent,<unk>  increases the toxicity of other nephrotoxins. Clinical studies have yielded<unk> ariable results, but animal models indicate some increased nephrotoxic effect probably occurs when<unk>  is added to nephrotoxins such as aminoglycosides. However, a dose- or serum level-effect relationship has not been established.
Vancomycin
Meropenem
Colistin
Resistin
Ertapenem
Teicoplanin
Aztreonam
Fosfomycin