摘要
萬古黴素是目前治療葛蘭氏陽性菌（尤其對methicillin抗藥的金黃色葡萄球菌[methicillin-resistant Staphylococcus aureus, MRSA]）引起嚴重感染的第一線藥物。使用上劑量必須依照體重及血中波谷濃度（trough level）校正。萬古黴素的腎毒性是最常見的副作用，在＞ 4 g/day的劑量下，其腎毒性機率將大幅增加。萬古黴素造成腎毒性的機轉尚未定論。但研究顯示主要機轉為急性腎小管壞死（acute tubular necrosis）與急性腎間質腎炎（acute interstitial nephritis）。萬古黴素引起腎損傷的處置類似於顯影劑引起之腎毒性，需大量點滴輸液與抗氧化藥物可以減緩腎損傷。但總體來說，各種危險因子的預防效益上遠勝於治療。
並列摘要
Vancomycin has been used for more than half a century and remains the first-line treatment for severe infections caused by Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA). The dosage of vancomycin must be adjusted by the body weight and plasma trough levels to avoid adverse effects. The most alarming adverse effect of vancomycin was nephrotoxicity. Nephrotoxicity is rare when vancomycin is used alone in standard doses but may be more common with higher doses (＞ 4 g/day) to prevent treatment failure in MRSA. Mechanisms of vancomycin induced nephropathy remain elusive. Most studies indicated the main mechanism as acute tubular necrosis and acute interstitial nephritis. Management to vancomycin induced renal toxicity is similar to the contrast-induced nephropathy. Maintaining adequate renal perfusion with intravenous hydration and anti-oxidant agents may reduce kidney damage. In summary, the prevention of various risk factors in vancomycin-induced renal toxicity is more effective than cure.