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Published Online, 27 April 2004, www.theannals.com, DOI 10.1345/aph.1D573.
 The Annals of Pharmacotherapy: Vol. 38, No. 6, pp. 1031-1038. DOI 10.1345/aph.1D573
© 2004 Harvey Whitney Books Company.
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INFECTIOUS DISEASES

Antimicrobial-Associated Renal Tubular Acidosis

Brian A Hemstreet, PharmD BCPS

Assistant Professor, Department of Clinical Pharmacy, School of Pharmacy, University of Colorado, Box C238, Denver, CO 80262-0238, fax 303/315-4630, Brian.Hemstreet{at}uchsc.edu

Reprints: Brian A Hemstreet PharmD BCPS.

OBJECTIVE: To review the literature documenting the association of various antimicrobial medications with the development of renal tubular acidosis (RTA).

DATA SOURCES: A search of the English literature via MEDLINE (1966–November 2003) and International Pharmaceutical Abstracts (1970–November 2003) was conducted to identify human reports of RTA associated with various drugs from all available classes of antimicrobial agents. Major search terms included renal tubular acidosis, acidosis, antibiotics, and antimicrobials. Bibliographies of selected articles were also searched to identify additional reports of RTA.

STUDY SELECTION AND DATA EXTRACTION: Case reports, observational studies, and experimental studies documenting the association of any antimicrobial agent with the development of RTA were included.

DATA SYNTHESIS: Antimicrobial-associated RTA is a relatively uncommon adverse effect, with most reports involving amphotericin B, trimethoprim/sulfamethoxazole, and outdated tetracycline. These agents may induce RTA either through direct tubular toxicity or as a function of their pharmacologic action. The time course for the development of RTA varies depending on the antimicrobial utilized. In most instances, RTA is reversible; however, some patients may experience prolonged recovery after the offending agent is removed.

CONCLUSIONS: Given that antimicrobial-associated RTA is a relatively uncommon adverse effect, review of the patient's drug regimen may reveal these agents as otherwise unrecognized causes of RTA. Likewise, underlying causes of RTA other than medications must be ruled out. Diagnosing antimicrobial-induced RTA may be difficult, given many of these agents may be used in combination and some are intrinsically nephrotoxic.

Key Words: acidosis, antibiotics, antimicrobials, renal tubular acidosis

Published Online, April 27, 2004. www.theannals.com, DOI 10.1345/aph.1D573

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-022-H01




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