[Gentamicin and amikacin nephrotoxicity: comparative study in patients with initially normal renal function].

Area of Science:

• Nephrology
• Pharmacology
• Infectious Diseases

Background:

• Aminoglycosides like gentamicin and amikacin are crucial for treating severe infections.
• Assessing the comparative nephrotoxicity of these agents is vital for patient safety.
• Previous studies have suggested varying nephrotoxic profiles for different aminoglycosides.

Purpose of the Study:

• To prospectively compare the nephrotoxic potential of amikacin (AK) versus gentamicin (GM).
• To evaluate nephrotoxicity in patients with initially normal renal function receiving these antibiotics.
• To establish which aminoglycoside poses a lower risk of kidney damage.

Main Methods:

• An open, comparative, prospective trial involving two groups of patients.
• Nephrotoxicity defined as a ≥50% increase in blood creatinine or exceeding normal levels.
• Peak and trough antibiotic levels monitored to guide dosing adjustments.

Main Results:

• Patients receiving gentamicin (n=27) showed significantly higher nephrotoxicity (56%) compared to amikacin (n=38, 18.2%).
• Clinical nephrotoxicity was also more frequent in the gentamicin group (18.5%) versus amikacin (5.2%).
• These differences persisted even after adjusting for patient age.

Conclusions:

• Gentamicin demonstrated significantly greater nephrotoxicity than amikacin in patients with normal baseline renal function.
• Amikacin appears to be a safer alternative regarding kidney function in this patient population.
• Careful monitoring and consideration of antibiotic choice are essential to minimize aminoglycoside-induced nephrotoxicity.