Restrictions Imposed on Antibiotic Therapy by Renal Failure

Abstract

When a drug which is normally excreted in large part by the kidneys is administered repeatedly to a patient with renal failure, it will tend to be retained and may accumulate in the body. The retention of large amounts of certain drugs can produce undesirable effects so that it may be prudent to reduce the size or frequency of the doses. On the other hand, undue caution may deny the patient adequate therapy and be as disadvantageous as overzealous treatment. Prolonged administration of large doses of some of the antibiotics currently in clinical use is not entirely innocuous. Liver and renal damage, negative nitrogen balance, and increased excretion of riboflavin as well as certain vitamins and amino acids into the urine may occur in patients treated with any of the tetracyclines.^1-9 Renal damage has been noted with the use of bacitracin,^10-14 the polymyxins,^15-22 neomycin,^15,23 and kanamycin.²⁴ Damage to vestibular or