BACKGROUND: Aminoglycosides (AGs) and vancomycin (VM) are potentially nephrotoxic antibiotics and their co-administration increases the incidence of nephrotoxicity in adult patients. Their combined effects on renal function in extremely low birth weight (ELBW) infants (<1,000 g) have not been previously reported. OBJECTIVES: Investigation of tubular disturbances in five ELBW neonates following repeated and prolonged treatment with a variety of AGs combined with VM. RESULTS: The drug levels were maintained in the neonatal therapeutic range. Renal tubular wasting of potassium, phosphate, and calcium, along with hypokalemia, was documented in all neonates studied while associated hypophosphatemia was observed in three of the five neonates and a transient rise in serum creatinine in four. The renal disturbances resolved completely 1-2 weeks after cessation of treatment. CONCLUSION: Renal tubular disturbances due to AG and VM treatment in ELBW neonates may be more common than they are diagnosed. Early detection and appropriate electrolyte supplementation may help to normalize serum electrolyte levels in these infants.
BACKGROUND:Aminoglycosides (AGs) and vancomycin (VM) are potentially nephrotoxic antibiotics and their co-administration increases the incidence of nephrotoxicity in adult patients. Their combined effects on renal function in extremely low birth weight (ELBW) infants (<1,000 g) have not been previously reported. OBJECTIVES: Investigation of tubular disturbances in five ELBW neonates following repeated and prolonged treatment with a variety of AGs combined with VM. RESULTS: The drug levels were maintained in the neonatal therapeutic range. Renal tubular wasting of potassium, phosphate, and calcium, along with hypokalemia, was documented in all neonates studied while associated hypophosphatemia was observed in three of the five neonates and a transient rise in serum creatinine in four. The renal disturbances resolved completely 1-2 weeks after cessation of treatment. CONCLUSION:Renal tubular disturbances due to AG and VM treatment in ELBW neonates may be more common than they are diagnosed. Early detection and appropriate electrolyte supplementation may help to normalize serum electrolyte levels in these infants.