Can ampicillin cause kidney damage?/nA 40-year-old female patient has had an afternoon fever (38.5)

Fråga: Can ampicillin cause kidney damage?

A 40-year-old female patient has had an afternoon fever (38.5), tiredness, cough, stomach problems and a high sedimentation rate (about 100) since the beginning of August. Doktacillin (ampicillin) treatment was begun in the beginning of October for 10 days (dose unknown). Her creatinine levels were: 27/8: 106; 28/9: 120; 20/10: 150; 2/11: 184 umol/l (reference: 110 nmol/l). Kidney biopsy showed interstitial nephritis with allergic changes.

Sammanfattning: Several cases of ampicillin-induced interstitial nephritis have been documented in the literature. In the present case, however, the cause-effect relationship is difficult to judge since the creatinine level was already increased before ampicillin was given.

Svar: Several case reports have been published concerning ampicillin-induced interstitial nephritis (1-3). Rennke and co-workers reported a case of a 58-year-old woman treated with ampicillin. While she was taking this medication a generalized skin rash developed. The patient also had peripheral oedema. Laboratory examination showed increased serum creatinine and heavy proteinuria. A renal biopsy showed interstitial oedema and inflammatory infiltration with lymphocytes, plasma cells, and eosinophils. Two months later the laboratory tests were normalized (1). Another case reported concerns a 20-year-old man treated with ampicillin. He developed an exanthema and an acute interstitial nephritis with acute renal insufficiency. Discontinuation of the ampicillin treatment and application of prednisolone led to a complete recovery from the clinical symptoms (2). Checchiri and co-workers have recently reported another case concerning a 82-year-old woman who developed acute renal insufficiency suggestive of nephrotic syndrome about one week after a cycle of ampicillin treatment. Symptoms were completely reversible and normal renal function was recovered (3).

The Swedish Adverse Drug Reactions Advisory Committee has received reports of two cases of renal insufficiency and one case of kidney damage in relation to ampicillin treatment. Although the drug-adverse effect connection was judged possible, other drugs were also involved in these cases.

The mechanism of antibiotic-induced interstitial nephritis is not completely clear. Clinical and experimental studies have suggested an allergic/immunological mechanism as discussed previously in Drugline (4). 1 Rennke HG, Roos PC, Wall SG: Drug-induced interstitial nephritis with heavy glomerular proteinuria. N Engl J Med 1980; 302: 691-692 2 Barnick P von, Stiller D, Glöckner R: Ampicillin-assoziierte akute interstitielle Nephritis mit Niereninsuffizienz - Kasuistische Mitteilung. Z Ges Inn Med 1983; 38: 502-505 3 Checchini M, Franzini C, Minora T, Omboni E: Acute renal damage caused by ampicillin. Description of a case. Minerva Med 1992; 83: 389-393 4 Drugline nr 08604 (year 1992)