Nephrotoxicity and Ototoxicity of Aztreonam versus Aminoglycoside Therapy in Seriously Ill Nonneutropenic Patients

• Published in: The Journal of infectious diseases Vol. 165; no. 4; pp. 683 - 688
• Main Authors: Moore, Richard D., Lerner, Stephen A., Levine, Donald P.
• Format: Journal Article
• Language: English
• Published: Chicago, IL University of Chicago Press 01.04.1992
• Subjects: Aminoglycosides; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Auditory Threshold - drug effects; Aztreonam - adverse effects; Aztreonam - therapeutic use; Bilirubin - blood; Biological and medical sciences; Cephalosporins; Clinical trials; Creatinine - blood; Diabetes; Dosage; Double-Blind Method; Drug toxicity and drugs side effects treatment; Female; Gram-Negative Bacterial Infections - drug therapy; Humans; Infections; Kidney - drug effects; Major Articles; Male; Medical sciences; Middle Aged; Nephrotoxicity; Pharmacology. Drug treatments; Predisposing factors; Regression Analysis; Risk Factors; State hospitals; Vestibule, Labyrinth - drug effects; Human; Urinary system disease; Toxicity; Kidney; Infection; In vivo; Chemotherapy; Treatment; Aminoglycoside; Bacteriosis; Double blind study; ENT disease; Antibacterial agent; Comparative study
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/165.4.683

A randomized double-blind clinical trial was done of aztreonam versus aminoglycoside therapy for the empiric treatment of seriously ill nonneutropenic patients suspected of aerobic gramnegative bacterial infection. Each patient was treated for ⩾72 h with the study drug. Nephrotoxicity, defined by ⩾50% increase in baseline serum creatinine, occurred in 12 (15%) of 92 patients receiving aminoglycoside therapy and 1 (1%) of 92 patients receiving aztreonam (P < .004). More severe nephrotoxicity, defined by ⩾100% increase in baseline serum creatinine, occurred in 6 (6.5%) of 92 patients receiving aminoglycoside therapy and in 1 of 92 receiving aztreonam (P < .11). Patients with an elevated baseline total bilirubin level were most likely to develop nephrotoxicity. Auditory toxicity occurred in 2 (7%) of 28 evaluatable patients receiving aminoglycoside therapy and in 1 (3%) of 33 receiving aztreonam (P < .58). One patient, who received aminoglycoside, developed vestibular toxicity. In nonneutropenic patients believed to be at increased risk for renal dysfunction, aztreonam is a less toxic alternative to aminoglycoside therapy for treatment of suspected aerobic gram-negative infection.