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The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy.
Of the nine cases in which AKI developed on day 3, five were likely, three were possibly and one was unlikely to be attributable to trimethoprim/sulfamethoxazole. Of these, 573 met inclusion criteria; the conditions for which trimethoprim/sulfamethoxazole was prescribed are shown in Table Data are shown as the number of patients (% of total patients in that column).Data are shown as the number of patients (% of total patients in that column).Flow chart showing the process by which the authors ascertained the patients under study.Flow chart showing the process by which the authors ascertained the patients under study.Of the 573 patients who met the inclusion criteria, 64 (11.2%) had increases in both serum creatinine and BUN that met predetermined criteria for AKI. Records of AKI patients were also studied for the presence of new onset rash or fever.Because of the high prevalence of underlying comorbid conditions that might contribute to AKI in our population, and in order to provide reassurance that any observed increase in creatinine and BUN in our study population was due to trimethoprim/sulfamethoxazole rather than to infection in a susceptible host, we also studied patients who received a course of clindamycin for a skin or soft tissue infection. Other possible contributing factors were identified in the remainder of cases, including exacerbation of a pre-morbid condition, volume depletion, diuresis, injection of contrast dyes and administration of potentially nephrotoxic drugs. If CNS adverse reactions including seizures occur, patients should undergo a neurological evaluation to determine whether treatment should be discontinued.Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Medical records of consecutive patients who received clindamycin during the same 3year period were searched to identify patients who were prescribed 600 mg by mouth three to four times daily for skin or soft tissue infection and met the same criteria as set out above for the availability of baseline and post-therapy determinations of serum creatinine and BUN.Descriptive analysis, including mean and standard deviation, was done for the continuous variables—age, baseline and post-treatment creatinine and BUN, and treatment duration. Antibiotic Renal Dosing Adjustment January 15, 2016 Levofloxacin (Levaquin) Normal renal dosing of 750 mg/day: CrCl 20-49 mL/min: 750 mg every 48 hours CrCl 10-19 mL/min: 750 mg initial dose, followed by 500 mg every 48 hours Normal renal dosing of 500 mg/day: CrCl 20-49 mL/min: 500 mg initial dose, followed by 250 mg every 24 hours In a multivariate model, patients with hypertension and diabetes mellitus had increased risk for renal insufficiency, especially if these conditions were considered poorly controlled.In a middle-aged male inpatient population treated for a minimum of 6 days, AKI is much more common with trimethoprim/sulfamethoxazole therapy than previously reported. There were no statistically significant differences in age or demographics when these patients were compared with 211 patients who received trimethoprim/sulfamethoxazole for skin or soft tissue infection (data not shown). For the purposes of this study, we reviewed the records of consecutive inpatients for whom any dose of trimethoprim/sulfamethoxazole was prescribed during a 3 year period. We also recorded the number of days the patient had received trimethoprim/sulfamethoxazole prior to documentation of AKI and, in patients for whom the serum creatinine returned to baseline within 1month, the time to return to baseline after discontinuation of trimethoprim/sulfamethoxazole.