Table 3.

Summary of clinical data for antibiotics with highest AKI signals in FAERS.

FAERS Rank	Antibiotic or Class	FAERS ROR	Key Points Regarding AKI
1	Polymyxins	33.1	Reported incidence in peer-reviewed literature: 8–60% Alternatives now available that have less AKI Consensus guidelines for dosing available when necessary
2	Aminoglycosides	17.4	Reported incidence in peer-reviewed literature: 5–25% Frequent monitoring and use of extended interval dosing help minimize the risk of AKI
3	Vancomycin	15.3	More than double the risk of AKI in both a meta-analysis (OR 2.45 vs. 0.3) and a randomized, controlled trial (Event rate: 18.2% vs. 8.4%) Higher trough concentrations are associated with increased AKI risk AUC-targeted dosing is associated with decreased AKI risk
4	Trimethoprim/sulfamethoxazole	13.7	Reversibly inhibits tubular secretion of creatinine, increasing creatinine without affecting GFR Slight increase in AKI risk compared to amoxicillin in a large cohort (2 additional AKI events per 1000 patients) Rate of AKI is dose dependent
5	Penicillin combinations (Beta-lactam/beta-lactamase inhibitor combinations)	8.0	Reported incidence in peer-reviewed literature: 1.7–38.5% Prolonged infusion NOT associated with AKI risk No clear difference in AKI risk between agents in this class
6	Clindamycin	6.5	True AKI incidence is unknown Primary report outside of FAERS is 24 AKI cases in China *
7	Cephalosporins	6.1	Primary observations of AKI risk are case reports Considered an alternative to decrease AKI risk compared to polymyxins or aminoglycosides AKI risk not impacted by prolonged infusion
8	Daptomycin	6.1	Reported incidence in peer-reviewed literature: 5–20% Risk of AKI consistently lower than vancomycin
9	Macrolides	3.6	Reported incidence in peer-reviewed literature: <0.5% AIN is possible as biopsy-proven cases have been published
10	Linezolid	3.5	Reported incidence in peer-reviewed literature: 6–10% Risk of AKI consistently lower than vancomycin
11	Carbapenems	3.3	Lower rates of AKI than polymyxins and piperacillin/tazobactam Cilastatin may have a protective effect vs. AKI
12	Metronidazole	2.6	Only one case report published No known mechanism for AKI
13	Tetracyclines	1.7	AIN has been documented in case reports Minocycline may have a nephroprotective effect
14	Fluoroquinolones	1.7	Absolute AKI risk increase: 6.5 events per 10,000 patient years Be aware of other fluoroquinolone safety risks in patients at risk of developing AKI

* No epidemiological data available as the studies included patients that had clindamycin-induced nephrotoxicity; Abbreviations: FAERS: Food and Drug Administration Adverse Event Reported System; ROR = relative odds ratio; AKI = acute kidney injury; OR = odds ratio; AUC = area under the curve; GFR = glomerular filtration rate; AIN = acute interstitial nephritis.