Antibiotic combination-associated nephrotoxicity in granulocytopenic patients with cancer

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Abstract
Antibiotic combination-associated nephrotoxicity was reviewed in 491 granulocytopenic patients with cancer and fever. Nephrotoxicity was defined as a rise in the serum creatinine level of > 0.4 mg/dl. The different aminoglycosides, when combined with ticarcillin disodium, were found to have an equivalent nephrotoxic potential and, for the purpose of analysis, were combined and termed aminoglycoside plus ticarcillin (Ags + ticarcillin). Groups treated with gentamicin or amikacin plus cephalothin sodium were combined and termed aminoglycoside plus cephalothin (Ags + cephalothin). The rate of nephrotoxicity was statistically less for the Ags + ticarcillin group, 8 (3.1%) of 262 patients, than for the Ags + cephalothin group, 23 (18.3%) of 126 patients. Age > 50 yr was a potentiating factor for the occurrence of nephrotoxicity in the Ags + cephalothin group. Thus, for granulocytopenic patients with cancer and fever, the antibiotic combination of the Ags + cephalothin evidently should not be used as empiric antibiotic therapy.