Strategies to prevent kidney injury from antibiotics in individuals with cystic fibrosis

Abstract

Kidney damage in cystic fibrosis (CF) patients is most commonly caused by antibiotics, such as aminoglycosides, which are used to treat Pseudomonas aeruginosa (PA). I conducted a survey of UK CF centres which showed a high rate of use of aminoglycosides in patients with no evidence of PA. I also conducted a Cochrane systematic review to assess the benefits and harms of strategies that may reduce or prevent kidney damage that is caused by intravenous antibiotic treatment. First, I attended necessary training courses for conducting a systematic review. I then wrote the protocol for the review and sent it off for peer review. I responded to the peer review comments making necessary adjustments to the protocol and it was then published. I then began the review process which involved running the searches and screening the results. We identified 54 studies that may be eligible for inclusion in the review. I was able to perform quantitative analysis and quality assessment on 4 of these. 2 studies looked at different combinations of intravenous antibiotics with no combination being more effective at preventing kidney injury. A study addressing time of dosing of tobramycin, showed a statistically significant increase in urinary excretion of KIM1 in the evening group with a mean difference of 0.73 (95% CIs 0.14 to 1.32), p=0.018 when compared to the morning group. Another study reviewed the use of nebulised tobramycin compared to intravenous tobramycin in acute exacerbations. There was a statistically significant increase in urinary excretion of protein, NAG, AAP and ß2-Microglobulin in the intravenous group compared to the nebulised group suggesting intravenous tobramycin is more nephrotoxic. Morning dosing of tobramycin and using nebulised tobramycin instead of intravenous tobramycin for acute exacerbations may reduce kidney injury. Larger studies are needed to assess these strategies further.