Cephalosporin

Incidence of nephrotoxicity in combination therapy. 199 patients with cancer and suspected sepsis, who received at least 20 doses of an aminoglycoside/ cephalosporin combination were propectively studied for drug-induced nephrotoxicity, Patients were randomly a~signed to receive either cephalothin I tobramycin or cephalothin/ gentamicin, or cefamandole/tobramycin, or cefaman-dolel gentamicin, Serum aminoglycoside levels were monitored to maintain 30 minute peak concentrations of 5-1 O)1g 1 ml and trough concentrations ofless than 2)1g/ mt. Nephrotoxicity was defined as a rise of greater than O.4mg/dl in serum creatinine during or after antibiotic therapy. There were 122 men and 77 women in the group. The age group r - I 7 years was defined as children and 18-68 years as adults. Of 125 children, 62 had leukaemia, 10 had lymphoma, and 53 had solid tumours, 34 of 74 adults had leukaemia, 9 had lymphoma, and J I had solid tumours, 168 (84.4 %) of the patients had less than 1000/ mm l

granulocytes at the start of treatment and so had carbenicillin added to their regimen, Patients receiving other nephroto)lic drugs or with septic shock were excluded from the study, Nephrotoxicity occured in 3,5 % of all patients, more often in adults (6.8 %} than in Children (] ,6 % ). In the adult group, 10.0 % of patients taking cephalothin 1 aminoglycoside developed nephrotoxicity (I of 14 on cephalothin/ tobramycin and 2 of 16 on cephalothin/ gentamicin), The corresponding figure in the cefamandolel aminoglycoside group was 4,5 %. These differences however, were not statistically significant. Neither was there any significant difference between groups receiving gentamicin or tobramycin, The incidence of nephrotoxicity was lower than had been reported in other studies, but the age range in this study was also lower and only patients with intially normal renal function were admitted, Brown, A,E, et 01.: Antimlcrobial Agents and

Chemotherapy 1 U92fApr 1982)

0157-7271/82/0625-0003/0$01.00/0 © AD'S Press Reactions 25 Jun 1982 3