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Aminoglycosides: assessing the potential for nephrotoxicity
1Department of Surgery, Harbor University of California, Los Angeles Medical Center, Torrance 90509.
Abstract:
Although aminoglycosides have been a mainstay of antibiotic therapy in postsurgical infections, certain patients may be at risk for potential aminoglycoside induced toxicities. Aminoglycoside nephrotoxicity is one of the most frequent causes of iatrogenic renal failure. A narrow toxicity to therapeutic ratio, a relatively long serum half-life and concentration in the renal cortex all contribute to renal dysfunction. Patients at greatest risk for aminoglycoside-induced nephrotoxicity include the elderly, patients with pre-existing renal disease and those who are volume depleted. Calculations based on the results of a multicenter study demonstrate that the average additional cost incurred for each patient who had aminoglycoside-related nephrotoxicity was $2,501. Methods are reviewed for prospectively assessing the potential for development of nephrotoxicity to identify patients for whom effective therapeutic substitutes for aminoglycosides should be sought.
Insights
Aminoglycoside antibiotics can cause kidney damage, especially in elderly patients or those with existing kidney issues. Identifying at-risk patients can help prevent costly nephrotoxicity and guide alternative treatments.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Aminoglycosides are crucial for treating postsurgical infections.
- Aminoglycoside-induced nephrotoxicity is a significant cause of iatrogenic renal failure.
- Factors like narrow therapeutic index and renal cortex concentration contribute to toxicity.
Purpose of the Study:
- To review methods for assessing nephrotoxicity risk.
- To identify patient populations at higher risk for aminoglycoside-induced nephrotoxicity.
- To guide the search for safer therapeutic alternatives.
Main Methods:
- Review of existing literature and multicenter study data.
- Analysis of risk factors associated with aminoglycoside use.
- Cost-benefit analysis of nephrotoxicity occurrence.
Main Results:
- Elderly patients, those with pre-existing renal disease, and the volume-depleted are at greatest risk.
- Aminoglycoside-related nephrotoxicity incurs an average additional cost of $2,501 per patient.
- Identification of key contributors to renal dysfunction.
Conclusions:
- Proactive assessment of nephrotoxicity risk is essential.
- Identifying high-risk patients allows for consideration of alternative antibiotics.
- Minimizing aminoglycoside nephrotoxicity improves patient outcomes and reduces healthcare costs.