Amoxicillin crystalluria: an emerging complication with an old and well-known antibiotic

Acute kidney injury during treatment with high-dose cloxacillin: a report of 23 cases and literature review

“…only three had hypereosinophilia). Fourthly, crystalluria was documented in one patient, suggesting that tubular precipitation of cloxacillin may occur, as reported with other penicillins [14][15][16]. Similar hypothesis were raised regarding nephrotoxicity of flucloxacillin, an isoxazolyl penicillin structurally close to cloxacillin [17].…”

Amoxicillin‐induced crystal nephropathy: A nationwide French pharmacovigilance databases study

“…It was first reported by a single hospital in Paris and further confirmed at the regional level by studying AICN cases reported to the regional centres of pharmacovigilance (RCPVs) of the Paris area. 4,11 In the latter study, only 1 case of AICN was reported from 1985 to 2010, while 44 cases were reported from 2010 to 2016. The most worrying point was that AICN occurred for 2/3 of cases in healthy patients undergoing scheduled surgery, without evident contributing factors in 2/3 of the cases.…”

“…4,7 Although the oral route of AMX or AMX-CLAV administration has been associated with AICN, most recently published AICN cases were associated with the intravenous route. [4][5][6][7][8][9][10][11] Several contributing factors for AICN have been suspected and include: high dose and/or too fast intravenous administration and/or administration of highly-concentrated solution of AMX, acid urine pH and dehydration. 3,4,6 Recently, an increase in AICN associated with the prescription of intravenous AMX/AMX-CLAV has been observed in the Paris area in France.…”

“…4 However, those studies were limited to the Paris area and the annual notification rate of AICN was not compared to intravenous AMX/AMX-CLAV sales, preventing from drawing any conclusion regarding the real increase of AICN in France. 4,11 Thus, the aim of this study was to investigate the annual notification rate, characteristics and outcome of AICN in France through 2 national complementary pharmacovigilance databases and to compare the trend in AICN annual notification rate to the trend in intravenous AMX/AMX-CLAV sales in France. • AICN may be responsible for life-threatening complications and may require renal replacement therapy caregivers and, since June 2011, all ADRs reported by patients themselves.…”

A child with macroscopic crystalluria: Answers

“…Nephrotoxicity is probably due to intratubular deposition of crystals, resulting in mechanical obstruction, medullary congestion, and papillary necrosis, but this has never been confirmed by renal biopsy [2,4]. Clinical presentation varies from asymptomatic cases without renal impairment to symptomatic crystalluria (abdominal or lumbar pain) with gross hematuria and/or renal insufficiency (progressing to obstructive uropathy with pelvis dilatation) [2,5]. Cases of acute renal failure occur essentially only in children after a massive drug overdose [4,6] or in adults receiving high-dose intravenous amoxicillin (200-320 mg/kg per day or >8 g/24 h for at least 48 h of therapy) [5,7].…”