Related Experiment Video

Updated: Jun 25, 2026

Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat
07:46

Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat

Published on: June 4, 2012

Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic

Sara E Cosgrove1, Gloria A Vigliani, Vance G Fowler

  • 1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. scosgro1@jhmi.edu

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 12, 2009
PubMed
Abstract

Insights

Adding low-dose gentamicin to Staphylococcus aureus endocarditis treatment increases nephrotoxicity. This practice should be avoided due to potential kidney damage, especially in older patients.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Clinical Pharmacology

Background:

  • The safety of combining initial low-dose gentamicin with antistaphylococcal penicillins or vancomycin for Staphylococcus aureus native valve endocarditis is not well-established.
  • This study aimed to assess the association between this therapeutic approach and the incidence of nephrotoxicity.

Purpose of the Study:

  • To evaluate the nephrotoxic potential of adding initial low-dose gentamicin to standard therapies for Staphylococcus aureus native valve endocarditis.
  • To identify risk factors for decreased creatinine clearance in patients with S. aureus bacteremia and native valve endocarditis.

Main Methods:

  • A prospective cohort study was conducted using safety data from a randomized controlled trial involving 236 patients with S. aureus bacteremia and native valve endocarditis.
  • Patients received either standard therapy plus initial low-dose gentamicin or daptomycin monotherapy.
  • Renal adverse events and clinically significant decreases in creatinine clearance were measured, including patients who received gentamicin shortly before enrollment.

Main Results:

  • Nephrotoxicity, indicated by decreased creatinine clearance, was significantly higher in patients receiving initial low-dose gentamicin (22%) compared to those who did not (8%).
  • Independent predictors of decreased creatinine clearance included advanced age (≥65 years) and the administration of any initial low-dose gentamicin.
  • Specific rates of renal adverse events and decreased creatinine clearance varied among vancomycin and antistaphylococcal penicillin recipients when combined with gentamicin.

Conclusions:

  • Initial low-dose gentamicin, when used as part of the therapy for Staphylococcus aureus bacteremia and native valve endocarditis, is associated with significant nephrotoxicity.
  • Routine use of initial low-dose gentamicin in this context is not recommended due to the observed renal risks and limited supporting evidence of benefit.

More Related Videos

Using a Bacterial Pathogen to Probe for Cellular and Organismic-level Host Responses08:38

Using a Bacterial Pathogen to Probe for Cellular and Organismic-level Host Responses

Published on: February 22, 2019

Related Concept Videos

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations01:15

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
Estimation of k and VD of Aminoglycosides01:20

Estimation of k and VD of Aminoglycosides

Aminoglycosides are a class of antibiotics used to treat various bacterial infections. Clinicians must determine the elimination rate constant (k) and volume of distribution (VD) to optimize therapeutic efficacy and minimize toxicity. The k value represents the rate at which the drug is removed from the body, and the VD reflects the degree to which the drug distributes into body tissues. Accurately estimating these parameters allows healthcare professionals to tailor drug dosing to individual...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Endocarditis I: Introduction01:25

Endocarditis I: Introduction

Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
Cardiac Catheterization I: Pre-Procedure Overview01:28

Cardiac Catheterization I: Pre-Procedure Overview

Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...