Antimicrobial nephrotoxicity

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1. Antimicrobials ( antibacterials, antivirals, antifungals) are important cause of nephrotoxicity and can result in acute renal failure.
2. The 4 major mechanisms of antimicrobial nephrotoxicity and the antimicrobial responsible are:
   1. M1- reduction in renal perfusion through alteration of renal hemodynamics ( amphotericin B)
   2. M2- direct tubular toxicity ( amphotericin B, aminoglycosides, foscarnet, pentamidine)
   3. M3-intratubular obstruction by precipitation of the agents or its metabolites or byproducts (sulfonamides, acyclovir, indinavir)
   4. M4- allergic interstitial nephritis ( sulfonamides, acyclovir, cephalosporins, ciprofloxacin, penicillins, rifampin)
3. Preventive measures include: avoid hypotension, dehydration, concurrent use of multiple nephrotoxic drugs, adjust the dosage according with the glomerular filtration rate, once a day administration, avoid electrolyte depletion, reduce the treatment course as much as possible, use appropriate interval dosing