Large vancomycin overdose in two premature infants with minimal toxicity.

Two premature infants received 10-fold overdoses of vancomycin with resulting peak plasma concentrations > 300 microg/mL. Discontinuation of vancomycin and watchful waiting were employed, with no specific intervention to accelerate vancomycin clearance. Plasma vancomycin concentration < 40 microg/mL was attained at < 48 hours in one infant and < 72 hours in the other. Although one infant sustained a transient increase in serum creatinine to 1.4 mg/dL, no further evidence of renal, auditory, or other toxicity was detected in either infant acutely or long term. Contemporary preparations of vancomycin appear much less toxic than earlier formulations. Aggressive and invasive interventions to hasten clearance may be unnecessary following overdose in infants with normal or near-normal basal renal function, although careful surveillance for clearance and toxic effects still appear warranted.