Tetracycline Uraemia in elderly patients: 2 case reportsTwo elderly patients developed uraemia after they received tetracycline as part of a regimen to eradicate Helicobacter pylori infection.The first patient, a 75-year-old woman, had a history of peptic ulcer and was anaemic. A test for H. pylori was positive and treatment was commenced with a 2-week regimen of omeprazole, metronidazole and tetracycline 500mg 4 times daily.During therapy, the woman became nauseous and was disorientated and somnolent. Blood tests indicated uraemia and abnormal liver function tests. After treatment was completed, her condition stabilised and her BUN level and liver function tests returned to normal. Examination of the patient's medical records revealed that she had moderate bilateral renal disease.The second patient, a 74-year-old man, had a large duodenal ulcer and H. pylori eradication therapy was initiated with a 2 week regimen as in the previous patient. He was discharged after 5 days of therapy but was readmitted 10 days later.At this time, the man was weak and his blood tests indicated severe uraemia (BUN level 45.3 mmol/L). His condition was stabilised with supportive care. No underlying renal disease was found.Author comment: 'The use of tetracycline carries the risk of uraemia . . . Patients obviously at risk are those with renal diseases likely to be associated with renal insufficiency . . . With this background, use of tetracycline as part of the H pylori eradication regimen in the elderly seems inappropriate.'
