Vancomycin and aminoglycoside antibiotics: kidney and hearing monitoring

Vancomycin is an antibiotic given in hospital by infusion into a vein. The NHS Fife guidance used for this page describes target levels for infections ranging from uncomplicated skin and soft tissue infection to deep-seated or severe infections such as bacteraemia, endocarditis, osteomyelitis and meningitis. Gentamicin, amikacin and streptomycin belong to the aminoglycoside family of antibiotics.

These are not medicines taken at home from a pharmacy. Because they are given in hospital or under specialist outpatient supervision, the monitoring is usually built into the care pathway, and patients may not hear every detail unless they ask.

Both medicines can affect the kidneys and the inner ear. The BNF entry for vancomycin states that both vancomycin and gentamicin can increase the risk of nephrotoxicity and of ototoxicity. The BNF gentamicin page repeats this from the other side and also lists loop diuretics such as furosemide and bumetanide as increasing the risk of nephrotoxicity with gentamicin.

NHS Fife antimicrobial guidance for vancomycin states that concurrent administration of neurotoxic or nephrotoxic agents increases the risk of vancomycin toxicity, that it should be avoided in patients with previous hearing loss because of potential ototoxicity, and that nephrotoxic drugs should be reviewed and possibly amended or withheld during treatment. That is the clinical logic: use the combination only where the infection requires it, and look for early signs of harm.

The NHS Fife guidance, written for hospital prescribers, sets out the pattern. A loading dose is given, then maintenance doses based on kidney function. A trough blood sample, taken just before a dose, is used to check the vancomycin level, with further levels every 2 to 3 days if kidney function is stable or daily if it is unstable. Target concentrations differ depending on the type of infection. The guidance also says to monitor renal function and check for signs of ototoxicity daily.

For a patient, this means regular blood tests, and checks for any change in your hearing. Do not feel you are being a nuisance by reporting these; they are exactly what the team is looking for.

Dose timing matters because levels are interpreted against the time of the last dose. The guidance emphasises recording dose and sample times accurately, which is why nurses are careful about both.

Tell the nurse or doctor promptly if you notice any change in your hearing. For the kidneys, the NHS lists symptoms of acute kidney injury as peeing a lot less than usual, feeling very thirsty, feeling or being sick, swollen feet or legs, feeling tired, dizzy, confused or sleepy, and feeling breathless, especially when lying down. Many people with mild AKI have no symptoms, which is why blood tests are the safeguard.

The NHS says AKI is diagnosed by a blood test measuring creatinine, and that if you have symptoms away from hospital you should ask for an urgent GP appointment or get help from NHS 111. Treatment can include stopping or changing any medicine that could be causing damage, fluids through a drip, and, if severe, dialysis for a short period.

Teams reduce risk by checking drug levels, monitoring kidney function and reviewing other medicines, as the Fife guidance sets out. The NHS lists NSAIDs, ACE inhibitors and diuretics among long-term medicines that can contribute to AKI, and dehydration, low blood pressure and infections or sepsis among causes, so the whole picture is relevant.

It helps to tell staff about all regular medicines, including over-the-counter painkillers, and to say if you have had kidney problems or hearing loss before. If you are well enough to be at home on a drip, the monitoring arrangements should be explained before you leave the ward.

Most people who need these antibiotics complete the course without lasting harm. If a kidney injury occurs, the NHS says many people recover fully within a few weeks, although a more serious injury can take several months, and some people end up with permanent damage and chronic kidney disease. After recovery you would normally have regular blood tests and check-ups.

The BNF is the standard UK prescribing reference in both NHS and private hospitals, so the interaction advice itself does not change by setting.