M028: KIDNEY TOLERANCE OF HIGH DOSE REGIMEN OF AMINOGLYCOSIDE
ANTIBIOTIC TREATMENT IN CF
L.Marzullo, M.Pelegrini, B.Tubino, L.Minicucci, L.Romano,
C.Romano University Dept. of Paediatrics and CF Cenlre, "G.
Gaslini" Institute - Genova. ltaly
Intensive antibiotic treatment is one of the most important principles of therapy in CF. It is generally admitted that higher doses of some antibiotics are needed, due to a peculiar pharmacokinetics in CF. The frequent use of antibiotics and the higher doses may increase the risk of cumulative complications or side effects. At the Genova CF Centre, intravenous aminoglycosides (AG) have been administered at the same suggested doses for non-CF patients until 1992. From January 1993, following international experience, AG dosage has been substantially increased. In order to evaluate nephrotoxicity of high doses of AG in CF, tests of renal function (serum creatinine, 24 h urinary protein electrophoresis) and kidney ultrasound structure have been analyzed in a group of patients treated both in 1992 and in 1993. Twenty-eight patients (10 males, 18 females), mean age 23.4 years (range 11-41 years), underwent 1 to 6 courses of 15 days of i.v. AG administration, in both the two years, at the following doses:
Table 1
Year 1992 1993
N.courses mg/Kg/day N.courses mg/Kg/day
Tobramycin 34 7.3 44 3.8
Netilmycin 4 7.8 13 15.4
Kidney function tests have been assessed at the beginning and at the end of each i.v. AG course. No patient showed proteinuria. Ultrasound scans have always shown a normal pattern of renal structure. Serum creatinine data are reported in Table 2
Table 2 Serum creatinine (mg/dl)
average (range) of all courses
Days of treatment 0 15 1992 0,75 (045-1,05) 0,79 (0,441,04) 1993 0,78 (0 15-1,18) 0,75 (0,52-1,02)
The observed changes of creatinine levels are not statistically significant with either dose regimen. In conclusion, no renal toxic reaction has been observed following treatment with AG at the indicated dosage. Renal function monitoring during treatment with AG is still indicated. The problem of ototoxicity has not yet been addressed. Renal and ototoxicity may become a frequent complication of AG treatment with increasing age and consequent number of A& courses in CF patients.