Antibiotics and acute renal failure in children with cystic fibrosis

Children with cystic fibrosis (CF) are treated with a large number of potentially nephrotoxic medications yet the incidence of renal failure is rare. The risk of nephrotoxicity with aminoglycosides is well appreciated and current CF guidelines suggest trough and peak levels should be monitored after the third or fourth dose, and then weekly with baseline renal function checked at the start of therapy. We recently treated three children with CF and acute renal failure all of whom had received gentamicin and ceftazidime in combination with other medication. Two children had a renal biopsy which showed acute tubular necrosis with additional interstitial nephritis in one. The patients required short term haemodialysis and recovered renal function. With other recently reported cases of CF and acute renal failure we would suggest that CF guidelines need to be amended to include monitoring of creatinine at the same times as gentamicin levels, particularly when combinations of antibiotics are being used or other risk factors are present.