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Renal function after hip arthroplasty and isoxazolylpenicillin prophylaxis
O Wahlström1, R Maller, K Djerf
1Department of Orthopedics, Faculty of Health Sciences, Linköping University Hospital, Sweden.
Acta Orthopaedica Scandinavica
|October 1, 1992
Summary
Dicloxacillin, unlike cloxacillin, temporarily impaired kidney function in hip arthroplasty patients. This transient injury to glomerular filtration suggests dose adjustments may be needed for older individuals receiving dicloxacillin.
Area of Science:
- Nephrology
- Pharmacology
- Orthopedic Surgery
Background:
- Isoxazolylpenicillins are commonly used for antibiotic prophylaxis in orthopedic surgery.
- Renal function monitoring is crucial after major surgical procedures, especially with antibiotic use.
Purpose of the Study:
- To compare the effects of cloxacillin and dicloxacillin on renal function following total hip arthroplasty.
- To assess potential subclinical renal injury induced by these antibiotics.
Main Methods:
- A comparative study involving 178 patients undergoing total hip arthroplasty.
- Patients received either dicloxacillin (n=85) or cloxacillin (n=93) as antibiotic prophylaxis (6g total dose over 36 hours).
- Serum creatinine and beta 2-microglobulin (serum and urine) were measured preoperatively and at 2, 4, and 10 days postoperatively.
Main Results:
- Patients treated with dicloxacillin exhibited a transient increase in serum creatinine and beta 2-microglobulin compared to the cloxacillin group.
- These biochemical changes indicate a temporary impairment of glomerular filtration.
- No significant renal impairment was observed in the cloxacillin group.
Conclusions:
- Dicloxacillin administration was associated with transient, subclinical renal injury in patients undergoing total hip arthroplasty.
- Cloxacillin did not demonstrate similar nephrotoxic effects.
- A reduction in dicloxacillin dosage is recommended for elderly patients to mitigate potential renal impact.