[Antiinfectious chemotherapy in renal insufficiency]

In patients with renal failure the administration of antiinfectious chemotherapeutic agents (antibiotics) raises two main problems. Antibiotics which are effective only by virtue of their high urinary concentration may lose their effect with reduced renal function (plasma creatinine above 1.5-1.7 mg%). This is true of nitrofurantoin, nalidixic acid, colistin and, to a lesser extent, sulfonamides. Decreased renal elimination of antibiotics may ultimately lead to accumulation and toxic side effects, and the dose of a given antibiotic should therefore be adapted to renal function. Simple dose-adaptation rules are proposed on the basis of plasma creatinine concentration as an index of renal function, a table listing the elimination constants of several antibiotics, and a nomogram which serves to determine graphically the appropriate global elimination constant for the individual patient and a given antibiotic.