Chinolonics and Renal Damages

From previous trials, the association between ciprofloxacin and acute renal failure, probably realized through immunological-like mechanisms, was signalled. An Italian trial now presents two cases of possible induction of crystal-induced nephropathy by ciprofloxacin. In both cases, (older) patients’ creatinine was about 1.0 mg/dl. Treatment consisted in the administration of 750 mg ciprofloxacin twice a day: after this intake, in a patient creatinine increased up to 7.0 mg/dl and in the other up to 8.3 mg/dl, with a renal biopsy which revealed in both cases the presence of star-like crystals in some tubules. Crystals, with a negative reaction for calcium and phosphates, were identical to the ciprofloxacin crystals described in previous trials.

(Nephrology)

Our comment:

The trial does not clear up the pathogenetic mechanism for the formation of crystals, but no doubt when a high-dose chinolonic must be used in an older patient, it is necessary to consider the possible renal damage and the possibility of acute renal failure. For these reasons, but not only for these ones, the use of a high-dose chinolonic in the older patient should not be considered as a first choice and should possibly be avoided.
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