Effect of ascorbic acid on colistin-associated nephrotoxicity: A preliminary clinical study.

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Effect of ascorbic acid on colistin-associated nephrotoxicity: A preliminary clinical study.

Antimicrob Agents Chemother. 2015 Mar 23;

Authors: Sirijatuphat R, Limmahakhun S, Sirivatanauksorn V, Nation RL, Li J, Thamlikitkul V

Nephrotoxicity is a dose-limiting factor of colistin, a last-line therapy for multidrug-resistant Gram-negative bacterial infections. An earlier animal study revealed a protective effect of ascorbic acid against colistin-induced nephrotoxicity. The present randomized controlled study was conducted in 28 patients and aimed to investigate the potential nephroprotective effect of intravenous ascorbic acid (2g every 12h) against colistin-associated nephrotoxicity in patients requiring intravenous colistin. Thirteen patients received colistin plus ascorbic acid whereas 15 received colistin alone. Nephrotoxicity was defined by the RIFLE classification system. Additionally, urinary neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl-beta-D-glucosaminidase (NAG) were measured as markers of renal damage, and plasma concentrations of colistin were quantified. The baseline characteristics, clinical features, and concomitant treatments of the patients in both groups were comparable. The incidence of nephrotoxicity was 53.8% (7/13) and 60.0% (9/15) in the colistin-ascorbic acid group and the colistin group, respectively (p=0.956, RR 0.9, 95% confidence interval 0.47-1.72). In both groups, urinary excretion rates of NGAL and NAG on day 3 to 5 of colistin treatment and at the end of colistin treatment were significantly higher than those at the respective baseline (p<0.05). However, urinary excretion rates of these biomarkers at the various times during colistin treatment did not differ significantly between the groups (p>0.05). Plasma colistin concentrations in both groups were not significantly different (p>0.28). The clinical and microbiological outcomes and mortality of the patients in both groups were not significantly different. This preliminary study suggests ascorbic acid does not offer nephroprotective effect for patients receiving intravenous colistin.

PMID: 25801556 [PubMed - as supplied by publisher]

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