Figure 1 shows the percentage of renal toxicity according to the vancomycin trough level. The highest percentage was found in the vancomycin trough level therapy >15 μg/mL (87.5%), with a significant difference when compared with low vancomycin trough level <10 μg/mL (P < 0.001). Fig. 1 Incidence of renal toxicity stratified by vancomycin steady-serum trough concentration Discussion MRSA infection in children

is treated mainly by vancomycin, a bactericidal glycopeptide antibiotic. There are two medical protocols regarding the use of vancomycin therapy in the treatment of serious infection caused by MRSA. One of these suggests keeping the trough serum vancomycin concentration at 5–10 μg/mL, Vadimezan as with other non-serious infections, and the other advises increasing the vancomycin level to between 10 and 15 μg/mL. The protocol applied in DMCH is the first vancomycin protocol that Caspase Inhibitor VI keeps the trough level between 5–10 μg/mL. The present study was performed to clarify the vague relationships among different variables in the studied

pediatric cases, such as age, weight, indication of vancomycin therapy, admission status, duration of therapy, concomitant nephrotoxin usage with vancomycin medication, vancomycin dosage and trough level, and renal functions status in studied children. The definition of renal failure terminology applied in the current study followed that in many documented references [8–10] as previously mentioned. In the studied literature, the incidence of renal failure in adult patients treated with vancomycin ranged from 12% to 42%, and this percentage was markedly elevated to reach its maximum percentage (42%) when other aminoglycoside medications were used with vancomycin therapy [12, 13]. In the present study, 27.2% of the studied children suffered from renal toxicity during vancomycin therapy, and the incidence of renal toxicity increased when the vancomycin trough level became >10–15 μg/mL (41%)

and reached its peak in 87.5% of cases with serum trough vancomycin Eltanexor concentration levels of >15 μg/mL. In accordance with the presented figures, several adult and pediatric studies documented the previously noted information Amino acid [8, 14]. In the present study, other factors have been reported that can affect the incidence of occurrence of renal toxicity beside the vancomycin serum level. These include duration of vancomycin therapy, concomitant usage of aminoglycosides, ICU admission status, presence of bacterial meningitis, presence of bacterial dermal infection, age, and weight of the studied pediatric cases. In the present study of 72 cases suffering from renal toxicity, there were 38 pediatric cases who were given aminoglycosides as well as vancomycin therapy. About one-third (37.4%) of the studied pediatric cases with high vancomycin trough levels were admitted to the ICU. The studied pediatric cases with high vancomycin trough levels of ≥10 μg/dL were associated with high mean overall vancomycin dose (41.