Ciclosporin Ceftazidime

A morbidly obese 17-year-old Hispanic girl, who had a cadaveric renal transplantation 5 years before, took ciclosporin and prednisone for stabilization. She was treated with chloramphenicol 875 mg qds and ceftazidime 2 g tds for vancomycin-resistant enterococcal sinusitis. There was a substantial and sustained increase in ciclosporin concentrations after chloramphenicol was added. Normalization was achieved after withdrawal of chloramphenicol. 

A comparative study in patients given gentamicin 30 mg with lincomycin just before renal transplantation found that the eoncurrent use of ciclosporin increased the incidence of nephrotoxieity from 5% to 67%. When gentamicin and lincomycin were replaced with ampicillin, ceftazidime and lincomycin the incidence of nephrotoxieity was 10%. Another study deseribes increased nephrotoxicity associated with the concurrent... 

Isolated case reports surest that ceftazidime, ceftriaxone, and latamoxef may increase ciclosporin levels, whereas one report suggested ceftazidime, ceftriaxone, and cefuroxime did not, although ceftazidime caused deterioration in some measures of renal function. 

Two kidney transplant patients had two- to fourfold rises in ciclosporin blood levels within 2 to 3 days of starting ceftriaxone 1 g twice daily. Levels fell when the antibacterial was stopped. The reason is uncertain but it was suggested that ceftriaxone possibly inhibits the metabolism of ciclosporin by the liver. However, a report of 51 kidney transplant patients stated that ceftriaxone and cefuroxime had no effect on ciclosporin blood levels and also that they were not nephrotoxic. This report also stated that ceftazidime did not affect serum ciclosporin levels, but it increased blood urea nitrogen and creatinine levels, indicating that it was nephrotoxic. A report briefly mentions that ceftazidime and latamoxef have also... 

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