Cephalosporin-induced nephrotoxicity: does it exist?

The literature has been reviewed to determine whether cephalosporins have been implicated in causing nephrotoxicity and to assess the influence of concomitant aminoglycoside therapy. Animal and human data have implicated cephaloridine and cephalothin in causing nephrotoxicity, both alone and in combination with aminoglycosides. There are few data implicating other cephalosporins in causing nephrotoxicity. Cefazolin, which is nephrotoxic in animals, has not been reported to produce nephrotoxicity in humans. Two studies have documented nephrotoxicity due to ceftazidime, especially in patients with preexisting renal impairment. Such patients should have their dosage adjusted to minimize ceftazidime-induced renal impairment. Finally, cephalosporins other than cephaloridine and cephalothin have not been documented to increase the risk of nephrotoxicity when used in combination with aminoglycosides compared with aminoglycosides alone.