Wilson S E
Department of Surgery, Harbor University of California, Los Angeles Medical Center, Torrance 90509.
Surg Gynecol Obstet. 1990;171 Suppl:24-30.
Although aminoglycosides have been a mainstay of antibiotic therapy in postsurgical infections, certain patients may be at risk for potential aminoglycoside induced toxicities. Aminoglycoside nephrotoxicity is one of the most frequent causes of iatrogenic renal failure. A narrow toxicity to therapeutic ratio, a relatively long serum half-life and concentration in the renal cortex all contribute to renal dysfunction. Patients at greatest risk for aminoglycoside-induced nephrotoxicity include the elderly, patients with pre-existing renal disease and those who are volume depleted. Calculations based on the results of a multicenter study demonstrate that the average additional cost incurred for each patient who had aminoglycoside-related nephrotoxicity was $2,501. Methods are reviewed for prospectively assessing the potential for development of nephrotoxicity to identify patients for whom effective therapeutic substitutes for aminoglycosides should be sought.
尽管氨基糖苷类药物一直是外科术后感染抗生素治疗的中流砥柱，但某些患者可能面临氨基糖苷类药物潜在毒性的风险。氨基糖苷类药物肾毒性是医源性肾衰竭最常见的原因之一。其毒性与治疗比值狭窄、血清半衰期相对较长以及在肾皮质中的浓度均会导致肾功能障碍。氨基糖苷类药物所致肾毒性风险最高的患者包括老年人、已有肾脏疾病的患者以及血容量不足的患者。基于一项多中心研究结果的计算表明，每例发生氨基糖苷类药物相关性肾毒性的患者平均额外花费为2501美元。本文回顾了前瞻性评估肾毒性发生可能性的方法，以确定应寻求氨基糖苷类药物有效治疗替代物的患者。
