Bailey R R, Peddie B, McRae C U
Clin Nephrol. 1982 May;17(5):258-61.
Little attention has been given to whether an effective concentration of an antibiotic is obtained in the urine of a patient without azotemia who has one poorly functioning kidney and a contralateral normal kidney. This study was undertaken to measure the concentration of various antibiotics in the urine from both kidneys of 20 patients with unilateral renal disease and a radiologically and functionally normal contralateral kidney. Prior to ureteric catheterization each patient received a single parenteral dose of an antibiotic. The peak urinary drug concentration from the damaged kidney per unit of its creatinine clearance exceeded that for the normal kidney for 11/13 patients treated with an aminoglycoside and 6/7 given a cephalosporin. The most severely damaged kidney had a creatinine clearance of 0.6 ml/min. This patient received sisomicin and the peak urinary concentration was only 1.8 micrograms/ml. If a damaged kidney has a creatinine clearance less than 10-15 ml/min it would seem more appropriate to use a cephalosporin rather than an aminoglycoside antibiotic.
对于没有氮质血症、一侧肾功能差而对侧肾正常的患者，其尿液中是否能达到抗生素的有效浓度，人们关注较少。本研究旨在测定20例单侧肾病患者患侧肾和放射及功能均正常的对侧肾尿液中多种抗生素的浓度。在输尿管插管前，每位患者接受一次抗生素的肠胃外给药。对于13例接受氨基糖苷类药物治疗的患者中的11例以及7例接受头孢菌素治疗的患者中的6例，患侧肾每单位肌酐清除率的尿药峰值浓度超过了对侧正常肾。受损最严重的肾肌酐清除率为0.6 ml/分钟。该患者接受了西索米星治疗，尿峰值浓度仅为1.8微克/毫升。如果受损肾的肌酐清除率低于10 - 15 ml/分钟，使用头孢菌素而非氨基糖苷类抗生素似乎更为合适。
