Aminoglycoside use in advanced renal failure

Abstract

Aminoglycosides are a group of antibiotics which are potentially nephrotoxic. Due to this hazard, many patients, particularly those with renal dysfunction, tend to be given lower doses of aminoglycosides, and this is a reason fro not obtaining the desired response. We have used aminoglycosides in high doses to achieve acceptable peak concentrations, both in the peritoneal fluid and in blood, while the frequency of administration of the drug varied, depending on renal function and trough concentrations of antibiotic. Ten patients (4 males, 6 females, aged 2-56 years0 in advanced failure, with clinical evidence of septicaemia and positive bacterial isolates from the peritoneal dialysate weretraeted with gentamicin, as the aminoglycoside of choice. Two patients had to be changed to netilmicin, when they had gentamicin resistance developing among the bacteria isolated from the dialysate. One patient in renal failure after Shigella dysenteriae type1 (Shigella shiga) infection and who had a gentamicin resistant Pseudomonas aeruginosa isolated from the dialysate, was treated with tobramycin. The in vitro minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of tobramycin against this isolate was lowest, in comparison to the aminoglycosides tested. Eight of these patients responded to theraphy with clinical recovery. Nephrotoxicity attributable to aminoglycosides alone was not observed during treatment. We conclude that appropriately chosen aminoglycosides when carefully monitored, are effective and safe in patients with severely impaired renal function.