To evaluate the creatinine clearance and compare nephrotoxic potential of amikacin and gentamicin, in post-operative patients with normal baseline renal function
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20163216Keywords:
Amikacin, Gentamicin, Nephrotoxicity, CreatinineAbstract
Background: The majority of infections on any surgical ward are usually due to one or more of the gram-negative bacilli. Among the different groups of antimicrobials that have been used to treat these infections, Aminoglycoside antibiotics such as Amikacin and Gentamicin are the most commonly used.
Methods: The study is 1 year, non-interventional, prospective study of patients administered either Amikacin or Gentamicin following surgery carried out in surgery ward in co-ordination with department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre Moradabad.
Results: The mean difference in final and initial serum creatinine values were observed to be 0.32 and 0.52 with a standard deviation of 0.228 and 0.387 in AM and GM group respectively. This difference was statistically significant with p value of 0.007. The mean difference in final and initial creatinine clearance values were observed to be 18.82 and 24.76 with a standard deviation of 10.14 and 11.93 in AM and GM group respectively. This difference was also statistically significant with p-value of 0.013. Nephrotoxicity occurred in 9 out of 50 patients (18%) in AM group out of which 12% were male and 6% were female whereas in case of GM group nephrotoxicity occurred in 16 out of 50 patients (32%) in which 26% were male and 6% were female.
Conclusions: From this study we can conclude that Gentamicin is more nephrotoxic and causes greater fall in creatinine clearance although the dose of Gentamicin administered is much lower compared to Amikacin.
References
Stone HH, Kolb LD, Geheber CE, Currie CA. Treatment of surgical infections with Tobramycin. Am Surg. 1975;41:301.
Nagai J, Takano M. Molecular aspects of renal handling of aminoglycosides and strategies for preventing the nephrotoxicity. Drug Metab Pharmacokineti. 2004;19:159-70.
Lauren G, Kishore BK, Tulkens PM. Aminoglycoside-induced renal phospholipidosis and nephrotoxicity. Biochem. Pharmacol. 1990;40:2383-92.
Leehey DJ, Braun BI, Tholl DA, Chung LS, Gross CA, Roback JA, et al. Can pharmacokinetic dosing decrease nephrotoxicity associated with aminoglycoside therapy. J Am Soc Nephrol. 1993;4:81-90.
Gilbert DN. Aminoglycosides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 4th ed. New York: Churchill Livingstone; 1995:279-306.
Lott RS, Hayton WL. Estimation of creatinine clearance from serum creatinine concentration. Drug Intell Clin Pharm. 1978;12:140-50.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
Martínez-Salgado C, López-Hernández FJ, López-Novoa JM. Glomerular nephrotoxicity of aminoglycosides. Toxicol Appl Pharmacol. 2007;223(1):86-98.
Ballesteros J, Northland R, Wolff M. Gentamicin and Amikacin nephrotoxicity: comparative study in patients with initially normal renal function. Rev Med Chil. 1989;117(1):10-7.
Sweileh WM. A prospective comparative study of gentamicin and Amikacin induced nephrotoxicity in patients with normal baseline renal function. Fundam Clin Pharmacol. 2009;23(4):515-20.
Hadjipour N. Histopathological comparision of Gentamicin and Amikacin nephrotoxicity in rabbits. Journal of Animal and Veterinary Advances. 2011;10(8):1003-6.
De Broe ME, Paulus GJ, Verpooten GA, Roels F, Buyssens N, Wedeen R, et al. Early effects of Gentamicin, Tobramycin, and Amikacin on the human kidney. Kidney International. 1984;25:643-52.
Bonadio M, Maccanti O, Giovannini L, Bertelli AA, Scalori V, Alessandrì MG, et al. Comparative nephrotoxicity and tissue accumulation of dactimicin, Amikacin and Gentamicin. Drugs Exp Clin Res. 1987;13(12):747-50.
Gilbert DN, Plamp C, Starr P, Bennett WM, Houghton DC, Porter AG. Comparative nephrotoxicity of Gentamicin and Tobramycinin Rats. Antimicrobial agents and chemotherapy, 1978;34-40.
French MA, Cerra FB, Plaut ME, Schentag JJ. Amikacin and gentamicin accumulation pharmacokinetics and nephrotoxicity in critically ill patients. Antimicrob Agents Chemother. 1981;19(1):147-52.
Gatell JM, San Miguel JG. Zamora L. Araujo V, Bonet M, Boht M, et al. Marin'. Comparison of the nephrotoxicity and auditory toxicity of tobramycin and Amikacin. Antimicrobial Agents And Chemotherapy. 1983;23(6):897-901.
Tripati KD. Essentials of medical pharmacology, 7th Edition. 2013;68.
