Aztreonam nephrotoxicity

Aztreonam, a monobactam, is a useful alternative for patients with aerobic gram-negative infections who are allergic to penicillins, but has no activity against anaerobes. Aztreonam appears to be the only p-lactam antibiotic that can be safely administered to penicillin-allergic patients [58]. Aztreonam has a spectrum of activity that is comparable to the aminoglycosides but it is less nephrotoxic in patients [59] and it appears to be well tolerated in infants and children [60]. 

Results from animal studies indicate that while furosemide enhanced cephaloridine nephrotoxicity no increased renal toxicity was observed by combining of piperacillin with furosemide [142]. Latamoxef and flo-moxef may decrease nephrotoxicity of vancomycin by inhibiting its uptake into the kidney [146,147]. The results of a retrospective study including renal transplant patients indicate that aztreonam can be safely administered with cyclosporine [148]. Combination therapy with ampicillin/aztreonam in neonates showed a lower renal toxicity than in the group with concurrent administration of oxacillin/ amikacin [149]. 

Reitbroeck RC, Hoitsma AJ, Koene RA. Aztreonam can be safely used with cyclosporin without aggravating nephrotoxicity. TranspI Int 1989 2(4) 232-234. 

Results of in vitro experiments carried out with rat renal microsomes and renal cortical slices showed that aztreonam has a low potential to induce reactive oxygen species and lipid peroxidation [10]. However, aztreonam caused a decrease in renal cortical accumulation of PAH comparable to that of paraquat without a significant decrease in TEA accumulation [10]. Therefore, it appears that the nephrotoxic activity of aztreonam may be not directly related to the superoxide generation and lipid peroxidation. 

Moore RD, Lerener SA, Levine, DP. Nephrotoxicity and ototoxicity of aztreonam versus aminoglycoside therapy. J Infect Dis 1992 165(4) 683-688. 

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