Gentamicin-induced Nephropathy

Abstract

162 consecutive gentamicin courses have been evaluated retrospectively with respect to nephrotoxicity of gentamicin (GM). Of these, 120 courses were administered in 106 patients for more than 2 days and under adequate control of plasma creatinine (PCr). In 62 of these 120 courses, PCr concentrations increased. In 17 courses (14%), GM therapy was found to be the only demonstrable etiology to the rise in PCr. The 17 courses with GM-induced reduction in kidney function were characterized by a prolonged duration of treatment, a high total dose of GM and a somewhat higher level of serum GM than the 58 courses of GM treatment in which PCr remained unchanged. No significant differences were found with regard to age, average daily dose of GM, average daily dose per kg and average daily dose in proportion to average diuresis. Additional administration of other nephrotoxic drugs did not increase the incidence of GM-induced nephropathy. When GM was the only demonstrable cause of nephropathy, the elevation in PCr concentrations were generally mild and transient, while the nephropathy when other factors were involved more often became severe and occasionally irreversible.

The Disputed Champion: Ampicillin and Gentamicin for Febrile Young Infants

“…Gentamicin nephrotoxicity appears to be related to the duration of use, the total dose administered, 14 the age of the patient, 15 and factors associated with impaired renal function. 16 With once-daily dosing, the transient high peak level does not cause toxicity. 17 Therefore, the risk of 1 or 2 doses of once-daily gentamicin is highly unlikely to cause nephrotoxicity.…”

Aminoglycoside Dosage in Pediatric Patients: Considerations Regarding Pharmacokinetic-Based Dose Adjustment in Patients Requiring High versus Low Dose Therapy

“…Antibiotic toxicity would be expected to be equal if related to AUC [18]. If, however, aminoglycoside toxicity is related to total dose [19], the high daily dose, cystic fibrosis and leukemic patients who received up to 21.6 mg/kg/day are potentially being placed at a greater risk for toxicity than the low daily dose neonate patients who received as little as 1.5 mg/kg/day. At the same time, it is imperative that equal consideration be given to efficacy.…”

Effect of furosemide on aminoglycoside-induced nephrotoxicity and auditory toxicity in humans

“…Only one clinical study evaluating aminoglycoside-induced nephrotoxicity has found that furosemide increases renal damage, whereas two studies have failed to find an interaction. None of these studies evaluated auditory toxicity (5,17,21). A few clinical reports have supported the association with auditory toxicity, but these studies have not included a control group and have reported small numbers of patients (8,9,11,12,14).…”