Penicillin nephrotoxicity

Nephrotoxicity may occur, especially in patients with preexisting renal disease. Severe hypersensitivity reaction including severe pruritus, angioedema, broncho-spasm, and anaphylaxis, particularly in patients with a history of allergies, especially to penicillins, may occur. 

Doxycydine (Adoxa, Periostal-, Oracea, Vibramycin, Vibra-Tabs) [Anribiotic/Tetracycline] Uses Broad-spectrum antibiotic acne vulgaris, uncomplicated GC, Chlamydia sp, PID, Lyme Dz, skin Infxns, anthrax, malaria prophylaxis Action Tetracycline bacteriostatic X- protein synth Dose Adults. 100 mg PO ql2h on 1st d, then 100 mg PO daily bid or 100 mg IV ql2h acne daily dosing, Chlamydia 7d, Lyme Dz 14—21 d, PID 14 d Peds >8 y 5 mg/kg/24 h PO, to a max of 200 mg/d - daily-bid Caution [D, +] Hepatic impair Contra Children <8 y, severe hepatic dysfxn Disp Tabs, caps, syrup, susp, inj SE D, GI disturbance, photosens Interactions T Effects OF digoxin, warfarin 1 effects W/ antacids, Fe, barbiturates, carbamazepine, phenytoins, food 4-effects OF penicillins EMS Monitor for signs of electrolyte disturbances and hypovolemia d/t D monitor for S/Sxs of super Infxn T risk of photosensitivity Rxns antibiotic of choice for the Tx and prophylaxis of anthrax exposure expired tetracyclines have been known to cause nephrotox OD May cause adverse GI effects symptomatic and supportive... 

Although cephalosporins are more toxic than penicillin, they are well tolerated. Parenteral injection may cause pain when given intramuscularly and may cause thrombophlebitis when given intravenously. The oral cephalosporin administration causes diarrhea by altering the gut ecology. Hypersensitivity reactions are caused and are similar to those of penicillins. Cephaloridine causes nephrotoxicity, but presently available cephalosporins have less renal toxicity. 

Tetracycline Tetracycline injections have an acid pH. Incompatibility may reasonably be expected with alkaline preparations or with drugs unstable at low pH. Care should be taken when administering tetracyclines, since chelation takes place with metal ions. Tetracyclines interact with inorganic metal ions. They should not be used with drugs that cause hepatotoxicity and nephrotoxicity (e.g., digoxin, theophylline, ergot alkaloids, methotrexate, oral contraceptives, and penicillins). 

Second, certain nucleotide phosphonates (e.g., adefovir and cidofovir) are effective antivirals, but their use in the clinic is limited by renal toxicity. This is believed to be caused by avid uptake at the basolateral membrane of renal proximal tubule cells followed by slow transport into the urine at the apical membrane, a sequence of events that results in intracellular drug accumulation and thus toxicity. As with penicillin, the OAT family of transporters has been implicated in cidofovir uptake. Co-administration of probenecid with cidofovir has been shown to decrease renal clearance of the antiviral and reduce its nephrotoxicity, presumably through com-... 

Cephalosporins are broad-spectrum antibiotics similar in structure to penicillin. For several cephalosporins, therapy is limited by the development of nephrotoxicity. Cephaloridine-induced nephrotoxicity has been examined extensively in laboratory animals and is characterized by an increase in blood urea nitrogen concentration within 24-48 hr, reductions in PAFI and TEA transport, and inhibition of glucose production following treatment. 

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]. 

Various p-lactam antibiotics such as cephalosporins and guanylureido penicillins may cause nonimmuno-logic nephrotoxic effects. The elucidation of the precise biochemical mechanisms involved in nephrotoxicity of P-lactams is of obvious importance for their rational and efficient utilization in the clinical management of infectious disease and for development of future cephalosporins. 

Tune BM, Browning MC, Hsu CY, Fravert D. Prevention of cephalosporin nephrotoxicity by other cephalosporins and by penicillins without significant inhibition of renal cortical uptake. J Infect Dis 1982 145(2) 174-180. 

Like penicillins, cephalosporins are a relatively nontoxic group of antibiotics. The primary adverse effect reported is hypersensitivity, a rare event. Cross-allergenicity with penicillins may occur. Toxicity is unlikely in children less than 6 years of age who acutely ingest less than 250 mg kg Nephrotoxicity is a possible, but rare, occurrence with acute ingestion. Coagulopathies have been reported following chronic intravenous use of certain cephalosporins. At higher... 

It is incumbent on health professionals to avoid toxic drugs whenever possible. Antibiotics associated with CNS toxicities, usually when not dose-adjusted for renal function, include penicillins, cephalosporins, quinolones, and imipenem. Hematologic toxicities generally are manifested with prolonged use of nafcillin (neutropenia), piperacillin (platelet dysfunction), cefotetan (hypoprothrombinemia), chloramphenicol (bone marrow suppression, both idiosyncratic and dose-related toxicity), and trimethoprim (megaloblastic anemia). Reversible nephrotoxicity classically is associated with aminoglycosides... 

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