ANTIMICROBIAL USE IN IMPAIRED RENAL FUNCTION

Use of antimicrobial agents in patients with varying

degrees of impaired renal function

* Antimicrobial agents requiring dosage change with impaired renal function.

Amikacin, carbenicillin, cefazolin, colistin, flucytosine, gentamicin, kanamycin, moxalactam, netimicin, polymyxin B, streptomycin, tobramycin (Amphotericin B to be used with caution because of its nephrotoxicity)

* Antimicrobial agents requiring dosage change only with severe renal failure.

Amoxycillin, ampicillin, cefonicid, cefotaxime, cefonetan, ceftazidime, cefoxitin, cefuroxime, cephalexin, cephalothin, ciprofloxacin, ethambutol, isoniacid, methicillin, nalidixic acid, norfloxacin, Penicillin G.

* Antimicrobial agents contraindicated in renal failure.

Cephaloridine, methanamine, nitrofurantoin, para-aminosalicylic acid, long acting sulfonamides, teracylines, (except doxycycline and possibly minocycline)

* Antimicrobial agents requiring no dosage change regardless of renal function.

Cefaclor, cefoperazone, ceftriaxone, chloramphenicol, clindamycin, cloxacillin, dicloxacillin, doxycycline, erythromycin, metronidazole, nafcillin, rifampicin.

* The following Antihypertensives require dosage changes in renal failures.

Atenolol, Acebutalol, ACE inhibitors, pindolol, Alpha methyl dopa, praxocin, hydralazine, clonidine hydrochloride.

BOX 2

EVIDENCE - BASED MEDICINE

Purpose and Procedure

The purpose of Evidence-Based Medicine is to alert clinicians to important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics and obstetrics and gynaecology by selecting from the biomedical literature those original and review articles whose results are most likely to be both true and useful. These articles are summarised in value-added abstracts and commented on by clinical experts.

The procedures followed are:

* Detecting, using prestated criteria the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields;

* Introducing these articles with declarative titles and summarising them in structured abstracts  that describe their objectives, methods, results, and evidence-based conclusions;

* Adding brief, highly expert commentaries to place each of these summaries in its proper clinical and health care context;

* Disseminating these summaries in a timely fashion to clinicians at every stage of their professional careers.