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The safety of cefuroxime and gentamicin in patients with reduced renal function
Abstract:
The glomerular and tubular function of 7 patients with a spectrum of renal impairment was measured before, during and after 4-days' treatment with cefuroxime and gentamicin. Neither the mean plasma urea nor creatinine concentrations of the group increased after combined treatment, nor was the excretion of cefuroxime slowed. The ability to acidify and to concentrate the urine did not change. In only 1 patient did plasma creatinine increase and GFR fall. This patient had an unexpectedly high plasma gentamicin concentration and was taking frusemide. However, an eighth patient with acute renal failure caused by bacteraemic shock rapidly recovered renal function while being treated with cefuroxime and gentamicin for 15 days after large doses of frusemide intravenously. This limited study suggests that the useful combination of cefuroxime and gentamicin need not be denied to patients with reduced renal function, but emphasizes that the plasma gentamicin concentration must always be monitored.
Insights
This study found that combining cefuroxime and gentamicin is safe for patients with reduced renal function. Careful monitoring of plasma gentamicin concentrations is essential to prevent adverse effects.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Renal impairment poses challenges for antibiotic selection.
- Cefuroxime and gentamicin are commonly used antibiotics.
- Assessing the safety of combined cefuroxime and gentamicin in renal impairment is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of combined cefuroxime and gentamicin treatment in patients with varying degrees of renal impairment.
- To assess the impact of this antibiotic combination on glomerular and tubular function.
Main Methods:
- Measured glomerular and tubular function in 7 patients with renal impairment.
- Monitored renal function before, during, and after a 4-day course of cefuroxime and gentamicin.
- Analyzed plasma urea, creatinine, and urine acidification/concentration.
Main Results:
- No significant increase in mean plasma urea or creatinine was observed in the group.
- Urine acidification and concentration abilities remained unchanged.
- One patient with high plasma gentamicin levels and frusemide use experienced decreased GFR, while another with acute renal failure recovered function.
Conclusions:
- Combined cefuroxime and gentamicin can be safely administered to patients with reduced renal function.
- Close monitoring of plasma gentamicin concentrations is critical.
- This combination may not need to be denied to patients with renal impairment, with careful monitoring.