Vancomycin-Associated Ototoxicity in Patients with Pre-existing Hearing Loss

Risk Factors and Monitoring Recommendations

The American Heart Association recommends avoiding the combination of vancomycin with aminoglycosides due to the high risk of ototoxicity and nephrotoxicity, particularly in patients with pre-existing hearing loss 2
The Infectious Diseases Society of America notes that routine audiograms during vancomycin therapy are not standard practice for healthy individuals, but may be necessary for patients with pre-existing hearing loss 1
Baseline audiometry is essential before initiating vancomycin therapy in patients with pre-existing hearing loss, as recommended by the American Journal of Respiratory and Critical Care Medicine 4 and the Annals of Oncology 5
Concomitant use of ototoxic agents, such as aminoglycosides and loop diuretics, significantly increases the risk of ototoxicity, as reported in the Clinical Infectious Diseases journal 1, Circulation journal 2, and European Respiratory Journal 3

The American Heart Association recommends using vancomycin with caution in patients with renal insufficiency, and adjusting the dose accordingly 2
Target vancomycin trough levels of 5-10 mg/L to minimize the risk of ototoxicity, as recommended by the Clinical Infectious Diseases journal 1

Patients with pre-existing hearing loss receiving vancomycin should be instructed to report tinnitus, vertigo, dizziness, or subjective hearing changes immediately, as recommended by the Clinical Infectious Diseases journal 1
Weekly audiometry should be considered for patients with pre-existing hearing loss receiving prolonged vancomycin therapy (>2-4 weeks), particularly in patients over 53 years 1