Interstitial nephritis methicillin

GI distress (NVD), especially ampicillin Jarisch-Herxheimer reaction in Rx of syphilis macu-lopapular rash (common with ampicillin) interstitial nephritis (methicillin). 

Fever may be the only evidence of a hypersensitivity reaction to the penicillins. The febrile reaction usually disappears within 24-36 hours after drug administration is stopped but may persist for days. Penicillins rarely cause interstitial nephritis methicillin has been implicated most frequently. 

Nephritis All penicillins, but particularly methicillin, have the potential to cause acute interstitial nephritis. 

DS Baldwin, BB Levine, T McCluskey. Renal failure and interstitial nephritis due to penicillin and methicillin. N Engl J Med 279 1245, 1968. 

Methicillin-induced acute interstitial nephritis follows a similar pattern of dose-dependence and time-dependence to that of neutropenia (185,186). This reaction occurred in 16% of all children treated with high-dose methicillin (187). Nephritis occurred after a mean of 17 days and a mean cumulative dose of 120 g. 

Cefalotin can cause two types of renal disease in man (111) acute tubular necrosis, similar to that seen with cefaloridine, although less often and acute interstitial nephritis, often accompanied by a rash, fever, or eosino-phUia, resembling the same disorder as that caused by methicillin. 

When 1500 mg/kg ampicillin was administered to female rabbits as a single dose, there was no evidence of nephrotoxicity judged by the absence of tubular necrosis 48 hours after administration [17]. In the other hand, carbenicillin, methicillin and ampicillin have been associated with acute interstitial nephritis (AIN) [18-20]. 

The incidence of interstitial nephritis, a probable hypersensitivity reaction, is reportedly higher with methicillin than uiih other penicillins. 

Penicillin-induced renal toxicity is most commonly seen as allergic acute interstitial nephritis (AIN). Methicillin is the most common penicillin to induce AIN, but the use of penicillin G, ampicillin, am-oxacillin, oxacillin, and carbenicillin also can lead to the development of AIN. Typically, acute renal failure follows 1 or 2 weeks of treatment with fever or rashes sometimes occurring before overt renal dysfunction. Removal of the penicillin generally allows renal function to return to normal within a few days or weeks. AIN can also be induced by certain cephalosporins (e.g., cephalothin, cephalexin, cephradine, cefoxitin, cefotaxime) and non-/i-lactam antimicrobials (e.g., sulfonamides, rifampicin, tetracyclines, erythromycin). 

Methicillin-induced allergic interstitial nephritis is the prototype for most presentations of AIN. Clinical signs present approximately... 

Incidence 5% to 7% with wide range of reactions (types I-IV). Urticarial skin rash common, but severe reactions, including anaphylaxis, are possible. Interstitial nephritis occurs with methicillin. 

Border WA, Lehmann DH, Egan JD, Sass HJ, Glode JE, Wilson CB (1974) Antitubular basement-membrane antibodies in methicillin-associated interstitial nephritis. N Engl J Med 291 381... 

Twenty-four cases of methicillin-induced interstitial nephritis from the literature have been reviewed (15 -). Usually reversal of the renal insufficiency occurs on withdrawal of methicillin. Though the pathogenesis is not completely understood it is generally believed that an allergic mechanism is involved. 

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