Nephrotoxicity of Combined Cephalothin-Gentamicin Regimen

Abstract

Gentamicin sulfate (Garamycin) is a broad spectrum antimicrobial agent member of the aminoglycoside group of antibiotics. This group, which also includes neomycin sulfate, kanamycin sulfate, and streptomycin sulfate,¹ is known to be nephrotoxic. Gentamicin-induced renal damage, however, has been recognized in only 2% of the subjects taking the medication, and this is usually manifested by a mild transient rise in blood urea nitrogen (BUN) level.^1,2 Recently, the first instance of severe acute renal failure in a patient receiving this drug only was reported by Kahn and Stein,³ although the structural lesion was not confirmed by biopsy. Cephalothin sodium (Keflin)-induced renal failure is also rare, and few cases have been reported in the literature.^4,5 Five times the usual therapeutic dosage is needed for the experimental production of mild histological changes in the renal tubules.⁴ We report the cases of two patients with histopathologically demonstrable acute tubular