trimethoprim--sulfamethoxazole-drug-combination and Renal-Insufficiency--Chronic

Antimicrobial pharmacology and its effect on prescribing is quite complex. Selecting an antibiotic that will optimally treat an infection while minimizing adverse effects and the development of resistance is only the first step, as one must also consider the patient's individual pharmacokinetic alterations and the pharmacodynamic properties of the drug when prescribing it as well. Patients with CKD may have alterations in their protein binding, volumes of distribution, kidney clearance, and nonrenal clearance that necessitates antibiotic dose adjustments to prevent the development of toxicity. Knowledge of a drug's pharmacodynamics, defined as the relationship between drug exposure and antibacterial efficacy, provides some guidance regarding the optimal way to make dose adjustments. Different pharmacodynamic goals, such as maximizing the time that free (unbound) drug concentrations spend above the minimum inhibitory concentration (MIC) for time dependent drugs (

Topics: Aminoglycosides; Anti-Bacterial Agents; Fluoroquinolones; Humans; Lipopeptides; Methicillin-Resistant Staphylococcus aureus; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination

The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Brain Abscess; Female; Humans; Kidney Transplantation; Linezolid; Male; Meropenem; Mycoses; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Voriconazole

Melioidosis has a high case fatality rate and is more common in patients with chronic kidney disease. Some authors recommended trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis for all hemodialysis (HD) patients during the wet season in melioidosis-endemic regions. Historical data were reviewed to determine if TMP/SMX prophylaxis was warranted in the HD population of Far North Queensland, Australia. Between 1997 and 2017, there were 242 culture-confirmed cases of melioidosis in the region, three (1.2%) occurred in HD patients; all survived without intensive care support. During the study period, there were 843 HD patients in the region with 3,024 cumulative patient years of risk. Even assuming 100% efficacy, it would have been necessary to prescribe TMP/SMX for 1,008 patient years to prevent one case of melioidosis. Given the significant additional cost and potentially life-threatening side effects of TMP/SMX therapy, clinicians should review the local epidemiology of melioidosis before the implementation of universal TMP/SMX prophylaxis in their HD population.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Burkholderia pseudomallei; Critical Care; Humans; Melioidosis; Middle Aged; Queensland; Renal Dialysis; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination

We present a special case of an 8-year-old girl diagnosed with severe drug reaction with eosinophilia and systemic symptoms due to trimethoprim-sulfamethoxazole for urinary tract infection prophylaxis for congenital vesicoureteral reflux. The patient is believed to have developed drug reaction with eosinophilia and systemic symptoms because of her underlying renal disease.

Topics: Anti-Bacterial Agents; Child; Drug Hypersensitivity Syndrome; Female; Glucocorticoids; Humans; Methylprednisolone; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Outbreaks ofPneumocystispneumonia have been described in renal transplant recipients. Aerosolized pentamidine is frequently used for prophylaxis in this setting. We report our experience with aerosolized pentamidine use in 56 renal transplant recipients. We found high rates of adverse reactions in patients with chronic respiratory disease.

Topics: Adult; Aerosols; Antifungal Agents; Bronchial Spasm; Female; Humans; Kidney Transplantation; Lung; Male; Pentamidine; Pneumocystis; Pneumonia, Pneumocystis; Renal Insufficiency, Chronic; Respiratory Tract Diseases; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination

Data on PCP in patients with glomerular disease are rare. The aim of this study was to assess the predictors of PCP development, the risk factors for mortality and the incidence of acute kidney injury (AKI) when high-dose trimethoprim-sulphamethoxazole (TMP-SMX) was used in patients with non-transplant glomerular disease.. Forty-seven patients with PCP, as confirmed by positive results for Pneumocystis jirovecii DNA or Pneumocystis jirovecii cysts tested by a methenamine silver stain between January 1, 2003, and December 30, 2012, were retrospectively investigated. The baseline characteristics of glomerular disease, clinical findings of PCP and renal parameters after treatment were collected. Predictors for PCP development and risk factors for mortality were determined using a multivariate logistic regression analysis.. All PCP patients exclusively received immunosuppressants. Baseline renal insufficiency [estimated glomerular filtration rate (eGFR) <60 mL/min·1.73 m. PCP is a fatal complication in patients with glomerular disease, and the use of immunosuppressants may be a basic risk factor for this infection. Underlying renal insufficiency and high renal pathology chronicity are the key risk factors for PCP in IgA nephropathy. TMP-SMX therapy remains an ideal choice because of high treatment response and frequently reversible kidney injury.

Topics: Acute Kidney Injury; Adult; Aged; Coinfection; Female; Glomerular Filtration Rate; Glomerulonephritis, IGA; Glomerulosclerosis, Focal Segmental; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Renal Insufficiency, Chronic; Respiration, Artificial; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Dose adjustment for certain drugs is required in patients with reduced renal function to avoid toxicity as many drugs are eliminated by the kidneys. The aim of this study was to assess whether appropriate dosage adjustments were made in hospitalized patients with renal impairment.. A prospective cross-sectional study was carried out in the internal medicine wards of Tikur Anbessa Specialized Hospital. All patients with creatinine clearance ≤ 59 ml/min admitted to hospital between April and July, 2013 were included in the analysis. Data regarding serum creatinine level, age, sex and prescribed drugs and their dosage was collected from the patients' medical records. Serum creatinine level ≥ 1.2 mg/dL was used as a cutoff point in pre-selection of patients. The estimated creatinine clearance was calculated using the Cockcroft- Gault (CG) equation. Guideline for Drug prescribing in renal failure provided by the American College of Physicians was used as the standard for dose adjustment.. Nine percent (73/810) of medical admissions were found to have renal impairment (CrCl  ≤ 59 ml/min). There were 372 prescription entries for 73 patients with renal impairment. Dose adjustment was required in 31 % (115/372) of prescription entries and fifty eight (51 %) prescription entries requiring dose adjustment were found to be inappropriate. Of 73 patients, 54 patient received ≥ 1 drug that required dose adjustment (median 2; range 1-6). Fifteen (28 %) patients had all of their drugs appropriately adjusted while twenty two (41 %) patients had some drugs appropriately adjusted, and seventeen (31 %) of patients had no drugs appropriately adjusted. No patients were documented to have received dialysis.. The findings indicate that dosing errors were common among hospitalized patients with renal impairment. Improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care.

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Aged, 80 and over; Allopurinol; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Anti-Ulcer Agents; Antifungal Agents; Antihypertensive Agents; Ceftazidime; Cimetidine; Creatinine; Cross-Sectional Studies; Digoxin; Diuretics; Drug Dosage Calculations; Drug Prescriptions; Enalapril; Ethiopia; Female; Fluconazole; Gout Suppressants; Hospitalization; Humans; Male; Medication Errors; Middle Aged; Pharmaceutical Preparations; Prospective Studies; Renal Insufficiency, Chronic; Severity of Illness Index; Spironolactone; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Young Adult

To evaluate the prognostic role of antenatal diagnosis of posterior urethral valves (PUVs) on ultimate renal function.. Between 1990 and 2010, 315 patients with PUVs were diagnosed and treated at 2 separate tertiary centers. Primary valve ablation was performed in all patients except 18, who underwent initial vesicostomy. Patients were divided into two groups: group 1 included 144 patients who were diagnosed antenatally, and group 2 included 171 patients with a postnatal diagnosis. Long-term functional and radiologic outcomes were assessed.. Follow-up was a median 5.5 years (range, 2-15 years). Mean age at ablation was 2.5 years (range, 1 day-15 years). Chronic kidney disease developed at the end of follow-up in 96 patients (30%): 27 (19%) in group 1 and 69 (40%) in group 2 (P <.05). The mean nadir serum creatinine was 0.6 and 0.8 mg/dL in groups 1 and 2, respectively, and the mean final serum creatinine was 0.9 and 1.7 mg/dL, respectively (P <.05). Persistent upper tract dilatation was noted in 43% of group 1 patients and in 69% of group 2 patients (P <.05).. The potential for recovering renal function is believed to be significant in patients in whom early detection of PUVs and, hence, early intervention was performed. Antenatal screening and detection of these patients might play a significant role in protecting the upper tract and reducing the incidence of chronic kidney disease.

Topics: Adolescent; Anti-Infective Agents; Child; Child, Preschool; Creatinine; Female; Humans; Incidence; Infant; Male; Pregnancy; Prenatal Diagnosis; Prognosis; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Vesico-Ureteral Reflux