Aminoglycosides renal disease

It is an aminoglycoside antibiotic used only as luminal amoebicide and has no effect against extra intestinal amoebic infections. It is less toxic than other agents, but it should be used cautiously in patients with significant renal disease and with gastrointestinal ulcer. 

Mars RL, Moles K, Pope K, Hargrove P. Use of bolus intraperitoneal aminoglycosides for treating peritonitis in end-stage renal disease patients receiving continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis. Adv Peril Dial 2000 16 280-4. 

J.E. Riviere. A Possible Mechanism for Increased Susceptibility to Aminoglycoside Nephrotoxicity in Chronic Renal Disease. New England Journal of Medicine, Vol. 307, pgs. 252-253,1982. 

As with other cases of ARF, ARF due to drugs is most often the consequence of multiple simultaneous insults. For example, Rasmussen and Ibels [4] found that 62% of 143 patients had more than one acute insult, including excessive aminoglycoside exposure and radiocontrast material administration. In the series of Davidman et al, [14], multiple causes of ARF were also present in 50% of 38 patients with drug-related renal disease. 

NAG, along with other urinary enzymes, has been used to evaluate drug induced tubular damage as in the case of acetaminophen [113], 5-aminosalicyate/ sulfasalazine in patients being treated for inflammatory bowel disease [114], and the relative nephrotoxicity of differing aminoglycoside dose schedules in neonates [115]. Assess of the urinary excretion of NAG have also been reported in hypertensive patients [116] and in patients with chronic renal failure due to various causes [117]. However, to date, it is considered to be an ancillary but non-definitive marker of renal disease. 

Papich and Riviere report marked variability in aminoglycoside pharmacokinetics (distribution, clearance, and half-life) with altered physiologic or pathologic states, including pregnancy, obesity, dehydration, immaturity, sepsis, endotoxemia, and renal disease. The latter influence is predictable from the fact that body clearance is dependent almost entirely on renal excretion. Martin-Jimenez and Riviere concluded that aminoglycoside pharmacokinetics can be predicted across species by population pharmacokinetic modeling. ... 

Though perhaps the ototoxic potencies of tobramycin may be lower than those of gentamicin, all risk factors associated with aminoglycoside therapy should nevertheless be taken into accoimt both before and during treatment with this antibiotic. In particular, attention should be paid to pre-existing renal disease, concomitant use of potentially nephrotoxic or ototoxic drugs (cephalo-... 

Renal failure will result in a diminished elimination of drugs that are primarily secreted, such as penicillins and aminoglycosides, and therefore in a longer half-life of the drug (45). Likewise, liver disease may result in a capacity-limited biotransformation, and consequently in a slower elimination of the drug. Bacterial pneumonia in calves may also result in increased serum oxytetracycline concentrations, a condition that can cause prolonged elimination (46). 

Adverse effects. Aminoglycoside toxicity is a risk when the dose administered is high or of long duration, and the risk is higher if renal clearance is inefficient (because of disease or age), other potentially nephrotoxic drugs are co-administered (e.g. 

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