Increasing Evidence of the Nephrotoxicity of Piperacillin/Tazobactam and Vancomycin Combination Therapy-What Is the Clinician to Do?
Anti-Bacterial Agents/administration & dosage/*adverse effects/therapeutic use/*toxicity; Combination/*adverse effects; Combined Modality Therapy/*adverse effects; Drug Therapy; Humans; Kidney Diseases/*chemically induced; Kidney/*drug effects/pathology; nephrotoxicity; Penicillanic Acid/administration & dosage/adverse effects/analogs & derivatives/therapeutic use/toxicity; Piperacillin; Piperacillin/administration & dosage/adverse effects/therapeutic use/toxicity; piperacillin/tazobactam; Sepsis; Sepsis/drug therapy; Tazobactam Drug Combination; vancomycin; Vancomycin/administration & dosage/adverse effects/therapeutic use/toxicity
Early administration of appropriate empiric antibiotics is essential for achieving the best possible outcomes in sepsis. Yet the choice of antibiotic therapy has become more challenging due to recent reports of nephrotoxicity with the combination of vancomycin and piperacillin/tazobactam, the "workhorse" regimen at many institutions. In this article we assess the evidence for nephrotoxicity and its possible mechanisms, provide recommendations for risk mitigation, address the advantages and disadvantages of alternative antibiotic choices, and suggest areas for future research.
Watkins Richard R; Deresinski Stan
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2017
2017-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/cix675" target="_blank" rel="noreferrer noopener">10.1093/cid/cix675</a>
Drug-induced acute renal failure: keys to recognizing and treating intrarenal toxicity.
Adult; Female; Male; Aged; Risk Factors; Kidney Function Tests; Kidney Failure; Physiologic; Monitoring; Nephrotoxicity; Antiinflammatory Agents; Non-Steroidal – Adverse Effects; Acute – Chemically Induced; Acute – Diagnosis; Acute – Therapy; Aminoglycosides – Adverse Effects; Amphotericin B – Adverse Effects; Contrast Media – Adverse Effects; Drugs – Adverse Effects; Nephrotoxicity – Prevention and Control
Drug-induced acute tubular necrosis is a primary cause of acute renal failure (ARF); it may result from the use of such agents as aminoglycosides, amphotericin B, and radilocontrast media. To reduce the risk of aminoglycoside toxicity, prescribe the shortest course possible, use once-daily dosing, monitor serum concentrations, and avoid using these agents altogether in patients with known risk factors. Radiocontrast media-associated ARF is most likely to occur with preexisting renal damage, especially in a patient with diabetes mellitus. Since sodium depletion is the most important risk factor for nephrotoxic injury with amphotericin B use, saline loading is recommended both before and during drug administration. Drug-induced acute interstitial nephritis, another important cause of ARF, has been associated with a number of antibiotics, especially penicillin and ampicillin; many patients recover with the removal of the offending agent.
Frazee L A; Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Drug-induced acute renal failure: recognizing and treating prerenal, postrenal, and pseudorenal injury.
Female; Male; Aged; Risk Factors; Hemodynamics; Physical Examination; Inpatients; Middle Age; Kidney Function Tests; Kidney Failure; Nephrotoxicity; Antiinflammatory Agents; Acute – Etiology; Angiotensin-Converting Enzyme Inhibitors – Adverse Effects; Antineoplastic Agents – Adverse Effects; Non-Steroidal – Adverse Effects; Acute – Chemically Induced; Acute – Diagnosis; Acute – Therapy; Enzyme Inhibitors – Adverse Effects; Renal Circulation – Drug Effects
Angiotensin-converting enzyme (ACE) inhibitors and NSAIDs are among the drugs most commonly associated with acute renal failure (ARF). Patients at risk for ACE inhibitor-induced ARF include those with congestive heart failure (CHF) or compromised left ventricular (IV) function and those receiving diuretics. In these settings, discontinue the ACE inhibitor and direct therapy toward correcting volume or improving the ineffective circulation (by appropriately reducing afterload, by ensuring adequate IV filling pressures, and by treating ischemia). Risk factors for NSAID-included ARF include CHI, poor renal perfusion, and recent hospitalization. Postrenal ARF may be precipitated by drugs that are highly insoluble in addic urine, such as antineoplastic agents and HmG-CoA reductase inhibitors. Alkalinization of urine and hydration are the cornerstones of management of this type of ARF.
Frazee L A; Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cephalexin-induced Acute Tubular Necrosis
acute tubular necrosis; cephalexin; cephalosporin antibiotics; cephalosporins; nephrotoxicity; Pharmacology & Pharmacy; renal failure; therapy
Longstreth K L; Robbins S D; Smavatkul C; Doe N S
Pharmacotherapy
2004
2004-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1592/phco.24.8.808.36069" target="_blank" rel="noreferrer noopener">10.1592/phco.24.8.808.36069</a>