Nephrotoxicity in isoxazolylpenicillin prophylaxis in hip surgery

Abstract

In 789 courses of antibiotic prophylaxis in hip arthroplasty surgery, either dicloxacillin (Diclocil) or cloxacillin (Ekvacillin) was used during two different time periods. The surgical methods, anesthesia, preoperative and postoperative care of the patients, and laboratory procedures were the same all the time. Changes in creatinine values were used as a method for evaluating the impact on renal function. When using dicloxacillin, a pathologic increase of creatinine was noted in 12 and 13 percent by two different calculation methods. Sixteen patients (4.2 percent) had a severe creatinine increase during the first postoperative week after dicloxacillin prophylaxis, requiring dialysis in 2 patients. Cloxacillin had only a marginal impact on renal function. Patients above aged 70 years were more vulnerable as regards renal function than younger persons, and the impairment was slightly dose related in all ages. In the dicloxacillin group, preoperative use of antiphlogistic drugs was correlated with reduced postoperative renal function.

Gentamicin-free bone cement does not alter proteinuria after hip arthroplasty

“…We found signs of postoperative glomerular and tubular renal impairment in all groups, but no differences between the groups, i.e., no indication that isoxazolyl penicillin was the cause of the renal impairment, as previously suggested (Isacsson and Collert 1984, Hedstrom and Hybbinette 1988, Wahlstrom et al 1992). …”

Renal impairment after hip or knee arthroplasty: Urinary excretion of protein markers studied in 59 patients

“…This differs from the results in previous studies (Isacson and Collert 1984, Hedstrom and Hybbinette 1988, Wahlstrom et al 1992a, and is probably a dilutional effect. A similar decrease in serum urea was observed by Stegmayr et al (1992) whose patients were similar to ours as regards bleeding (1 L) and transfusion (median 1 unit) .…”

“…Previous studies have indicated postoperative renal impairment in about 10-15% of all patients undergoing hip arthroplasty (Gelman et al 1979), mainly in patients on systemic antibiotic prophylaxis with isoxazolyl penicillins (Isacson and Collert 1984, Hedstrom and Hybbinette 1988, Ahnfelt and Steen 1992, Wahlstrom et al 1992a. However, in patients receiving dicloxacillin and operated with gentamicinfree bone cement, only slight signs of tubular dysfunction were found one week after surgery (Stegmayr et al 1992).…”

“…Previous authors have studied glomerular function after THR by following serum creatinine levels (Isacson and Collert 1984, Hedstrom and Hybbinette 1988, Wahlstrom et al 1992a. These could rise due to the large muscular trauma in hip surgery and it does not rise until the glomerular filtration rate is reduced by 40-50%.…”

“…Morand and Littlejohn nal function, following hip arthroplasty, and com-( I 990) considered reduced renal function to be the commonest postoperative medical problem after THR and in some cases acute renal failure was fatal (Isacson andCollert 1984, Morand andLittlejohn 1990). Prophylactic systemic antibiotic treatment, with isoxazolyl penicillins, can contribute to renal dysfunction (Isacson and Collert 1984, Nordbring 1984, Hedstrom and Hybbinette 1988, Wahlstrom et al 1992a. Other reasons could be preexisting renal dysfunction in these often elderly patients, an effect of the stress and hemodynamic instability during anesthesia and surgery, or an adverse effect of drugs given peror postoperatively.…”