Vancomycin and Zosyn combination can cause elevated creatinine. In one case on ID, on a patient who was still intubated and recovering from septic shock on Vancomycin, Zosyn, and Clindamycin whose creatinine was rising from 1.8 to 3.1, we discontinued Zosyn and started Cefepime. We held vancomycin and gave it only when the Vancomycin trough was less than 15.
Why does this happen?