One hundred five patients receiving concurrent aminoglycoside and vancomycin therapy of at least 5 days' duration were retrospectively reviewed for development of nephrotoxicity. All had their vancomycin and aminoglycoside serum concentrations controlled by a clinical pharmacokinetics service. Nephrotoxicity occurred in 28 (27%) of the patients. Twenty-two of the 28 had other factors that are known to contribute to renal failure (amphotericin B therapy, sepsis, liver disease, obstructive uropathy, pancreatitis, anesthesia). The remaining six developed nephrotoxicity without other known contributing factors. Logistic regression analysis revealed associations between nephrotoxicity and age, sex, aminoglycoside trough and vancomycin peak and trough serum concentrations, length of aminoglycoside and vancomycin therapy, concurrent amphotericin B therapy, liver disease, neutropenia, and peritonitis (p less than 0.05). In addition to factors previously reported, this study found that neutropenia and peritonitis are associated with an increased risk of nephrotoxicity. Patients with one or more risk factors warrant close monitoring of renal function as well as vancomycin and aminoglycoside serum concentrations.

Aged↗

PubMed1977

Immunoprophylaxis of experimental Mycoplasma pneumoniae disease: effect of aerosol particle size and site of deposition of M. pneumoniae on the pattern of respiratory infection, disease, and immunity in hamsters.

The distribution of Mycoplasma pneumoniae infection in the respiratory tract and the extent of pulmonary pathology were determined by the site of deposition and the number of organisms administered to hamsters. Infection of the upper and lower areas of the respiratory tract occurred when organisms were introduced into both areas by small-particle aerosol (2.3 micrometer) or by intranasal (i.n.) instillation of a 200-microliter inoculum. In contrast, when organisms were delivered primarily to the upper respiratory tract by large-particle aerosol (8 micrometer) or by i.n. instillation of a small volume of inoculum (2 or 20 microliter), infection remained limited to this area in most or all instances. When the lungs became infected after i.n. administration of a 200-microliter inoculum, the most extensive pulmonary lesions were seen in the animals given the largest number of organisms. Each of the modes of administration of M. pneumoniae initiated an infection which conferred measurable resistance to a subsequent challenge capable of inducing extensive pulmonary disease. The most effective resistance was induced by the two modes of administration which produced an infection involving the entire respiratory tract, i.e., small-particle aerosol or i.n. instillation of a 200-microliter inoculum.

Administration, Intranasal↗

PubMedDate not supplied

Hepatic and renal dysfunction following nafcillin administration.

OBJECTIVE: To review four cases of combined hepatic and renal toxicity that may be associated with the administration of nafcillin in adults. This type of adverse event with the use of nafcillin has not been previously documented in the literature. DATA SOURCES: References from pertinent articles are identified throughout the text. DATA SYNTHESIS: Nafcillin is a widely used penicillinase-resistant penicillin. In four patients receiving nafcillin doses greater than 9 g/24 hours, changes in renal and hepatic function markers were noted within 72 hours of the initiation of nafcillin therapy. Laboratory values returned toward baseline when nafcillin therapy was discontinued. Elevations in blood urea nitrogen, creatinine, total bilirubin, and lactate dehydrogenase have been previously described in the literature for penicillin-like agents other than nafcillin. The exact mechanism for such toxicities as well as patient risk factors have not been clearly established. CONCLUSIONS: Caution should be taken when initiating nafcillin therapy. Evaluation of renal and liver function tests prior to initiating nafcillin therapy and within the first 72 hours appears warranted. If hepatic and/or renal toxicity is observed, discontinuation of nafcillin should be considered.

Aged↗