Cefuroxime-Induced Acute Renal Failure

Leong, Chee Loon; Thiruventhiran, T.

doi:10.1159/000045568

Cited by 7 publications

(6 citation statements)

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“…Manufacturer’s specifications and the literature indicate that cefuroxime as well as gentamicin can induce acute renal failure. 46 , 47 Overall, no severe side effects occurred, which could be linked to systemic gentamicin exposure.…”

Section: Discussionmentioning

confidence: 91%

Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Moghaddam

Graeser

Westhauser

et al. 2016

TCRM

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IntroductionOsteitis is one of the most serious complications in orthopedic surgery. Expert Tibia Nail (ETN) PROtect™ coated with a biodegradable layer of gentamicin-laden polymer was developed for prophylaxis of osteomyelitis. In systemic administration, gentamicin has only a small therapeutic index and serious side effects; it is potentially nephrotoxic as well as ototoxic. It is not yet known if relevant gentamicin concentrations are released into the systemic circulation after implantation of gentamicin-coated nails. In order to evaluate the patients’ risks profiles and increase patient safety, we measured gentamicin levels in pre- and postoperative serum samples of patients undergoing implantation of ETN PROtect.MethodsTwenty-five patients who received ETN PROtect between March 2012 and August 2014 were included in this study. Collection of blood samples occurred before the operation, at weeks 1–4, 3 and 6 months, and up to 1 year after the implantation. Measurement of gentamicin levels in serum samples was performed at the central laboratory of Heidelberg University Hospital. Additionally, laboratory parameters, C-reactive protein, leukocyte number, urea and creatinine concentrations were analyzed in routine controls before and after operating and assessed for systemic side effects.ResultsOver the course of this prospective observational study, we were able to determine that gentamicin-coated nails do not release gentamicin into the systemic circulation above the lowest detectable level of 0.2 mg/dL. There were slight increases in the mean inflammation and renal retention markers, but no gentamicin-associated side effects could be linked to implantation. Furthermore, no allergic reactions could be detected during our study.ConclusionOur findings suggest that there is no relevant release of gentamicin into the systemic circulation causing a systemic effect, and serious side effects due to gentamicin-coated tibia nails should not be feared. Postoperative monitoring of renal function does not seem necessary because of the implantation of ETN PROtect.

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Section: Discussionmentioning

confidence: 91%

Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Moghaddam

Graeser

Westhauser

et al. 2016

TCRM

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“…So far, not many papers have been published on cefuroxime allergy. Some reported cases of allergic reactions to cephalosporin, including cefuroxime, were limited to case reports [25,26,27,28,29]. Romano et al [30] reported 30 subjects who experienced an immediate allergic reaction to at least one of the injectable cephalosporins.…”

Section: Discussionmentioning

confidence: 99%

Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Caimmi

Galera

Bousquet-Rouanet

et al. 2010

Int Arch Allergy Immunol

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Objective: In patients sensitized to β-lactams, a safe β-lactam alternative is often needed. The objective was to assess the safety of cefuroxime in patients with a proven β-lactam allergy. Design: Using the Drug Allergy and Hypersensitivity Database cohort, patients with a proven β-lactam allergy and tested for cefuroxime between September 1996 and April 2007 were selected. The European Network of Drug Allergy recommendations were followed. Prevalence of sensitization to cefuroxime (as an alternative) was established in patients with a proven β-lactam allergy. Results: Amongst the 650 subjects tested, 143 (22.0%) presented at least one β-lactam sensitization other than cefuroxime [39–27.3% male, median age at test 44.0 (32.0–56.0) years]. One hundred and eighteen (82.5%) were sensitized to penicillins, 8 (5.6%) to cephalosporins and 17 (11.9%) to both penicillins and cephalosporins. Nine (6.3%) patients were sensitized to cefuroxime (6 diagnosed by provocation test): 5 (55.6%) in the penicillin-only allergic group and 4 (44.4%) in the penicillin and cephalosporin allergic group. Prevalence of cefuroxime hypersensitivity reaction in patients sensitized to β-lactams was 6.3% (95% CI 2.3–10.3%) and in those sensitized to penicillin 4.2% (95% CI 0.6–7.9). This rate decreased to 2.9% (95% CI 0–6.9) in patients with prior histories involving a penicillin only (without any history involving an unknown β-lactam). Conclusion: Cefuroxime appeared to be a safe alternative in β-lactam-allergic patients after testing. The risk of giving cefuroxime being not null, a thorough drug allergy work-up, including provocation test, is still needed.

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“…Leong and al. have described a case of acute renal failure by interstitial nephritis after Cefuroxime-axetil administration [9].…”

Section: Experimental Partmentioning

confidence: 99%

“…Allergies to Cephalosporins are usually represented by maculo-papular skin eruption, dizziness, fever, positive Coombs test, positive antiglobulin, urticaria, angioedema, rhinitis, bronchospasm, serumsickness-like reactions and anaphylaxis [6]. Extremely rare, it can manifest through renal complications, like acute interstitial nephritis or acute renal failure and drug-induced cytopenias [6][7][8][9][10].…”

mentioning

confidence: 99%

“…Kounis syndrome, also called allergic angina, described for the first time in 1991 [11], is characterized by appearance of acute coronary syndrome in the presence of platelets, basophils or mast cells activation, due to an allergic reaction, hypersensitivity, anaphylactic reaction or shock [9]. The triggers are drugs [12][13][14], environmental exposure [15], chemicals [16], foreign bodies [17] and some specific diseases associated with inflammatory mediators' release [18].…”

mentioning

confidence: 99%

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Intraoperative Anaphylactic Shock Following Cefuroxime-Axetil Routine Test Case report and literature review

Ţigliş¹,

Mester²,

Hurmuzache³

et al. 2019

Rev. Chim.

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Approximately 72% of patients with anaphylaxis present cardio-vascular manifestations, with only few reported cases of cardiogenic shock and cardiac arrest. Cephalosporins are the most used antibiotics for prophylaxis in the perioperative period with a prevalence of allergic reactions between 1-3%. Cefuroxime, a second-generation semisynthetic cephalosporin, presents relatively rare anaphylactic reactions (0.015%). Kounis syndrome is characterized by appearance of acute coronary syndrome in the presence of platelets, basophils or mast cells activation, due to an allergic reaction, hypersensitivity, anaphylactic reaction or shock. We report a rare case of a 53-year-old female patient with intraoperative anaphylactic shock following Cefuroxime-axetil routine test, complicated with Kounis syndrome and finally with cardiac arrest.

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Cefuroxime-Induced Acute Renal Failure

Cited by 7 publications

References 3 publications

Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Intraoperative Anaphylactic Shock Following Cefuroxime-Axetil Routine Test Case report and literature review

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Cefuroxime-Induced Acute Renal Failure

Cited by 7 publications

References 3 publications

Patients&rsquo; safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Patients&rsquo; safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Safety of Cefuroxime as an Alternative in Patients with a Proven Hypersensitivity to Penicillins: A DAHD Cohort Survey

Intraoperative Anaphylactic Shock Following Cefuroxime-Axetil Routine Test Case report and literature review

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Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?

Patients’ safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use?