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[Acute renal failure with high-dose combination therapy with penicillin G and amoxicillin]
F K Tegtmeyer1, J Otte, U Thyen
1Klinik für Pädiatrie, Medizinischen Universität Lübeck.
Insights
High-dose amoxicillin in a child caused kidney injury, leading to macrohematuria and anuria. Prompt treatment reversal resolved the acute tubular obstruction and papillary necrosis, highlighting amoxicillin crystalluria risks.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Infectious Diseases
Background:
- A 3-year-old girl presented with suspected bacterial meningitis.
- Initial assessment revealed no prior history of renal, cerebral, or allergic issues.
Observation:
- Following 36 hours of high-dose Penicillin G and Amoxicillin therapy, the patient developed macrohematuria and anuria.
- Diagnostic workup excluded other causes like cardiocirculatory failure, Schwartz-Bartter reaction, or coagulatory failure.
Findings:
- Sonographic and urinalysis findings indicated acute tubular obstruction and papillary necrosis.
- Amoxicillin crystalluria was identified as the likely cause of renal dysfunction.
Implications:
- High-dose amoxicillin (over 300 mg/kg/day) poses a risk of tubular obstruction due to crystalluria.
- Maintaining adequate diuresis and urine alkalization is crucial for ampicillin solubility and preventing renal complications.
Abstract:
A 3 year old girl was admitted with suspected bacterial meningitis. The patient's history concerning renal and cerebral function and known allergies had been uneventful until that time. 36 h after initiation of a high dose antibiotic therapy with Penicillin G (0.5 Mega IE/kg/day) and Amoxicillin (400 mg/kg/day) macrohematuria and consecutive anuria was observed. Prerenal cardiocirculatory failure, a Schwartz-Bartter-reaction as well as coagulatory failure could be ruled out. There were no symptoms of hypersensitivity. Sonographic examinations of the kidneys and the urinary tract as well as urinanalysis suggested an acute tubular obstruction and papillary necrosis caused by amoxicillin. After changing the antibiotic regimen to chloramphenicol and induction of diuresis by furosemide and dopamine renal failure could be resolved within 39 h. The patient recovered completely. High dose therapy with amoxicillin (greater than 300 mg/kg/day) includes the risk of tubular obstruction due to cristalluria. Solubility of ampicillin in aqueous fluids (6.5 mg/ml at pH 7) should be supported by sufficient diuresis and urine alkalization.