Question

Karen, a 48-year-old divorced pilot, and mother of two (ages 10 and 15). Admission assessment includes a history of diabetes.  Karen informs you that she has been told by the physician that she has a urinary tract infection with Pseudomonas. The doctor orders aminoglycoside therapy as part of her treatment. She is anxious about her problem and to hurry up and get better.

1. For which two serious toxicities will you monitor, what are their symptoms, and how can they be prevented?

2. The physicians adds penicillin to Karen's drug regimen. Explain the reason for this.

3. Karen's "trough" aminoglycoside level is 3.0 mcg/L, and her serum creatinine level is increased from 1.0 to 1.6 within the past two days. Are these results a concern? What should you do? Explain  

Answer 1

1.The main serious toxicities during under treatment of aminoglycoside are drug induced nephrotoxicity and ototoxicity.

Symptoms of nephrotoxicity : It is same as acute renal failure

• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Drowsiness
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Seizures or coma in severe cases
• Chest pain or pressure.

Symptoms of aminoglycoside ototoxicity are:

Bilateral high-frequency sensorineural hearing loss.

Tinnitus.

Cochleotoxic and vestibulotoxic effect.

Prevention :

• Monitor serum drug levels and renal function.
• Assessment of hearing before, after and during therapy.
• Avoid noisy environment for 6months after therapy because the aminoglycoside remain in cochlear and is susceptible to rise increased cochlear damage.
• Can select alternative antibiotics.

2)When these two medicines are taken together, penicillin may react with your aminoglycoside and cause the aminoglycoside to be less effective and reduces the complications which can be caused by aminoglycoside. And also pencillin helps in treating urinary tract infection.

3)if Serum Creatinine is more than 0.5 - 1mg/dl it indicates drug induced Nephrotoxicity. So here Karen'sS. Creatinine is 1.6which clearly shows nephrotoxicity. Therefore it is a concern.

So careful monitoring of serum drug levels and renal function.

Stop aminoglycoside and can select alternative antibiotics.