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. 1979 Nov;55(649):791–796. doi: 10.1136/pgmj.55.649.791

Tobramycin nephrotoxicity. A prospective clinical study

Antonio Coca, Alberto Martinez, Eladio Soriano, Juan Blade, Fernando Segura, Manuel Ribas-Mundo
PMCID: PMC2425802  PMID: 523366

Abstract

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appel G. B., Neu H. C. The nephrotoxicity of antimicrobial agents (second of three parts). N Engl J Med. 1977 Mar 31;296(13):722–728. doi: 10.1056/NEJM197703312961305. [DOI] [PubMed] [Google Scholar]
  2. Bobrow S. N., Jaffe E., Young R. C. Anuria and acute tubular necrosis associated with gentamicin and cephalothin. JAMA. 1972 Dec 18;222(12):1546–1547. [PubMed] [Google Scholar]
  3. Britt M. R., Garibaldi R. A., Wilfert J. N., Smith C. B. In vitro activity of tobramycin and gentamicin. Antimicrob Agents Chemother. 1972 Sep;2(3):236–241. doi: 10.1128/aac.2.3.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burton J. R., Lichtenstein N. S., Colvin R. B., Hyslop N. E., Jr Acute renal failure during cephalothin therapy. JAMA. 1974 Aug 5;229(6):679–682. [PubMed] [Google Scholar]
  5. Carling P. C., Idelson B. A., Casano A. A., Alexander E. A., McCabe W. R. Nephrotoxicity associated with cephalothin administration. Arch Intern Med. 1975 Jun;135(6):797–801. [PubMed] [Google Scholar]
  6. Del Bene V. E., Farrar W. E., Jr Tobramycin: in vitro activity and comparison with kanamycin and gentamicin. Antimicrob Agents Chemother. 1972 Apr;1(4):340–342. doi: 10.1128/aac.1.4.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dosik G. M., Gutterman J. U., Hersh E. M., Akhtar M., Sonoda T., Horn R. G. Nephrotoxicity from cancer immunotherapy. Ann Intern Med. 1978 Jul;89(1):41–46. doi: 10.7326/0003-4819-89-1-41. [DOI] [PubMed] [Google Scholar]
  8. Engle J. E., Drago J., Carlin B., Schoolwerth A. C. Letter: Reversible acute renal failure after cephalothin. Ann Intern Med. 1975 Aug;83(2):232–233. doi: 10.7326/0003-4819-83-2-232_2. [DOI] [PubMed] [Google Scholar]
  9. Fillastre J. P., Laumonier R., Humbert G., Dubois D., Metayer J., Delpech A. Insuffisances rénales aiguës après administration de céphalotine et de gentamycine. Nouv Presse Med. 1973 Feb 17;2(7):444–444. [PubMed] [Google Scholar]
  10. Fillastre J. P., Laumonier R., Humbert G., Dubois D., Metayer J., Delpech A., Leroy J., Robert M. Acute renal failure associated with combined gentamicin and cephalothin therapy. Br Med J. 1973 May 19;2(5863):396–397. doi: 10.1136/bmj.2.5863.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hoff G. E., Schiotz P. O., Paulsen J. Tobramycin treatment of pseudomonas aeruginosa infections in cystic fibrosis. Scand J Infect Dis. 1974;6(4):333–337. doi: 10.3109/inf.1974.6.issue-4.07. [DOI] [PubMed] [Google Scholar]
  12. Hollenberg N. K., Adams D. F., Oken D. E., Abrams H. L., Merrill J. P. Acute renal failure due to nephrotoxins. N Engl J Med. 1970 Jun 11;282(24):1329–1334. doi: 10.1056/NEJM197006112822401. [DOI] [PubMed] [Google Scholar]
  13. Jaffe G., Ravreby W., Meyers B. R., Hirschman S. Z. Clinical study of the use of the new aminoglycoside tobramycin for therapy of infections due to gram-negative bacteria. Antimicrob Agents Chemother. 1974 Jan;5(1):75–81. doi: 10.1128/aac.5.1.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Klastersky J., Hensgens C., Debusscher L. Empiric therapy for cancer patients: comparative study of ticarcillin-tobramycin, ticarcillin-cephalothin, and cephalothin-tobramycin. Antimicrob Agents Chemother. 1975 May;7(5):640–645. doi: 10.1128/aac.7.5.640. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kleinknecht D., Ganeval D., Droz D. Acute renal failure after high doses of gentamicin and cephalothin. Lancet. 1973 May 19;1(7812):1129–1129. doi: 10.1016/s0140-6736(73)90447-9. [DOI] [PubMed] [Google Scholar]
  16. Kosek J. C., Mazze R. I., Cousins M. J. Nephrotoxicity of gentamicin. Lab Invest. 1974 Jan;30(1):48–57. [PubMed] [Google Scholar]
  17. Landes R. R., Melnick I., Hoffman A., Fehrenbaker L. Tobramycin, a new aminoglycoside antibiotic: Experience in urinary tract infections. South Med J. 1975 Jan;68(1):116–117. doi: 10.1097/00007611-197501000-00031. [DOI] [PubMed] [Google Scholar]
  18. Lane A. Z., Wright G. E., Blair D. C. Ototoxicity and nephrotoxicity of amikacin: an overview of phase II and phase III experience in the United States. Am J Med. 1977 Jun;62(6):911–918. doi: 10.1016/0002-9343(77)90660-x. [DOI] [PubMed] [Google Scholar]
  19. Lau W. K., Young L. S., Black R. E., Winston D. J., Linne S. R., Weinstein R. J., Hewitt W. L. Comparative efficacy and toxicity of amikacin/carbenicillin versus gentamicin/carbenicillin in leukopenic patients: a randomized prospective trail. Am J Med. 1977 Jun;62(6):959–966. doi: 10.1016/0002-9343(77)90669-6. [DOI] [PubMed] [Google Scholar]
  20. Lerner S. A., Seligsohn R., Matz G. J. Comparative clinical studies of ototoxicity and nephrotoxicity of amikacin and gentamicin. Am J Med. 1977 Jun;62(6):919–923. doi: 10.1016/0002-9343(77)90661-1. [DOI] [PubMed] [Google Scholar]
  21. Lockwood W. R., Bower J. D. Tobramycin and gentamicin concentrations in the serum of normal and anephric patients. Antimicrob Agents Chemother. 1973 Jan;3(1):125–129. doi: 10.1128/aac.3.1.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Méndez Martin A., Ortíz González A. Fracaso renal agudo por la asociacion de cefalotina y gentamicina. Rev Clin Esp. 1974 May 31;133(4):365–370. [PubMed] [Google Scholar]
  23. Pasternak D. P., Stephens B. G. Reversible nephrotoxicity associated with cephalothin therapy. Arch Intern Med. 1975 Apr;135(4):599–602. [PubMed] [Google Scholar]
  24. Pennington J. E., Reynolds H. Y. Tobramycin in bronchial secretions. Antimicrob Agents Chemother. 1973 Sep;4(3):299–301. doi: 10.1128/aac.4.3.299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Plager J. E. Association of renal injury with combined cephalothin-gentamicin therapy among patients severely ill with malignant disease. Cancer. 1976 Apr;37(4):1937–1943. doi: 10.1002/1097-0142(197604)37:4<1937::aid-cncr2820370445>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  26. Szwed J. J., Luft F. C., Black H. R., Elliott R. A., Kleit S. A. Comparison of the distribution of tobramycin and gentamicin in body fluids of dogs. Antimicrob Agents Chemother. 1974 May;5(5):444–446. doi: 10.1128/aac.5.5.444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Tobias J. S., Whitehouse J. M., Wrigley P. F. Letter: Severe renal dysfunction after tobramycin/cephalothin therapy. Lancet. 1976 Feb 21;1(7956):425–425. doi: 10.1016/s0140-6736(76)90256-7. [DOI] [PubMed] [Google Scholar]
  28. Welles J. S., Emmerson J. L., Gibson W. R., Nickander R., Owen N. V., Anderson R. C. Preclinical toxicology studies with tobramycin. Toxicol Appl Pharmacol. 1973 Jul;25(3):398–409. doi: 10.1016/0041-008x(73)90313-x. [DOI] [PubMed] [Google Scholar]
  29. Wick W. E., Welles J. S. Nebramycin, a new broad-spectrum antibiotic complex. IV. In vitro and in vivo laboratory evaluation. Antimicrob Agents Chemother (Bethesda) 1967;7:341–348. doi: 10.1128/AAC.7.3.341. [DOI] [PubMed] [Google Scholar]

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