The Effect of Vitamin C in Preventing Vancomycin-Induced Nephrotoxicity; A Randomized Clinical Trial Study

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Resident, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Vancomycin-induced nephrotoxicity is a common complication in patients under treatment with this drug, but no single theory has been proposed for prevention of this damage. The purpose of this study was to determine the beneficial effect of vitamin C in the preventing vancomycin-induced renal disease.Methods: In a clinical trial study, 96 patients treated with vancomycin were divided into two equal groups, in the first group 500 mg oral vitamin C was administered twice daily for ten days and in the control group, no intervention was performed. Patients in the two groups were evaluated at baseline, and 2, 4, 6, 8, and 10 days later for serum creatinine, creatinine clearance, and renal toxicity, and the results were compared.Findings: The incidence of vancomycin-induced nephrotoxicity was 3 and 6 patients in the intervention and control groups (6.25% vs. 12%), respectively, and there was no significant difference between the two groups (P = 0.320). However, the relative risk (RR) of vancomycin-induced nephrotoxicity in the control group was 4.1 times that of the vitamin C group [RR = 4.1; 95% confidence interval (CI): 1.12-15.4; P = 0.034].Conclusion: Vitamin C intake reduces the risk of vancomycin-induced renal toxicity; it is recommended, as is useful in preventing oxidative stress poisoning.

Keywords

References

  1. Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, et al. Vancomycin therapeutic guidelines: A summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 2009; 49(3): 325-7.
  2. Pauly DJ, Musa DM, Lestico MR, Lindstrom MJ, Hetsko CM. Risk of nephrotoxicity with combination vancomycin-aminoglycoside antibiotic therapy. Pharmacotherapy 1990; 10(6): 378-82.
  3. Rahimzadeh G, Farshidi F, Rezai MS, Rezai S. The effect of bacteriophages against gram-negative bacteria infections in vivo: A systematic review. J Isfahan Med Sch 2019; 37(524): 427-34. [In Persian].
  4. Iwamoto T, Kagawa Y, Kojima M. Clinical efficacy of therapeutic drug monitoring in patients receiving vancomycin. Biol Pharm Bull 2003; 26(6): 876-9.
  5. Ceriello A, Esposito K, Ihnat M, Thorpe J, Giugliano D. Long-term glycemic control influences the long-lasting effect of hyperglycemia on endothelial function in type 1 diabetes. J Clin Endocrinol Metab 2009; 94(8): 2751-6.
  6. Basarslan F, Yilmaz N, Ates S, Ozgur T, Tutanc M, Motor VK, et al. Protective effects of thymoquinone on vancomycin-induced nephrotoxicity in rats. Hum Exp Toxicol 2012; 31(7): 726-33.
  7. Vora S. Acute renal failure due to vancomycin toxicity in the setting of unmonitored vancomycin infusion. Proc (Bayl Univ Med Cent) 2016; 29(4): 412-3.
  8. Appenroth D, Frob S, Kersten L, Splinter FK, Winnefeld K. Protective effects of vitamin E and C on cisplatin nephrotoxicity in developing rats. Arch Toxicol 1997; 71(11): 677-83.
  9. Maliakel DM, Kagiya TV, Nair CK. Prevention of cisplatin-induced nephrotoxicity by glucosides of ascorbic acid and alpha-tocopherol. Exp Toxicol Pathol 2008; 60(6): 521-7.
  10. Panonnummal R, Varkey J, Dinoop DR. Protective effect of atorvastatin against vancomycin induced nephrotoxicity in albino rats. Pharmacie globale 2011; 2(8): 1-6.
  11. Dalaklioglu S, Tekcan M, Gungor NE, Celik-Ozenci C, Aksoy NH, Baykal A, et al. Role of the poly(ADP-ribose)polymerase activity in vancomycin-induced renal injury. Toxicol Lett 2010; 192(2): 91-6.
  12. Hung YM, Lin SL, Hung SY, Huang WC, Wang PY. Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography. World J Cardiol 2012; 4(5): 157-72.
  13. Spargias K, Alexopoulos E, Kyrzopoulos S, Iokovis P, Greenwood DC, Manginas A, et al. Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 2004; 110(18): 2837-42.
  14. Akundi S, Lee YR, Perry GK, Fike DS, Mnjoyan S. Nephrotoxicity in recipients of vancomycin vs. vancomycin with vitamin C. International Journal of Medicine and Pharmacy 2015; 3(2): 1-15.
  15. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007; 53(4): 766-72.
Journal of Isfahan Medical School
Volume 37, Issue 542 - Serial Number 542
July and August 2019
Pages 1068-1073

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History

  • Receive Date: 22 August 2019
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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