The Australian and New Zealand Society of Nephrology
The Australian and New Zealand Society of Nephrology is a not-for profit organisation representing the interests of health professionals committed to the prevention and treatment of kidney disease. Through the ANZSN, members support a range of research, education and clinical care initiatives to promote evidenced based practice and quality outcomes for patients in Australia, New Zealand and our region.
1.
Do not give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single daily dose
Aminoglycosides are powerful and widely used antibiotics. Acute kidney injury (AKI) is a well-known complication of aminoglycosides. Because efficacy of these antibiotics is concentration-dependent rather than time-dependent and their renal toxicity depends more on duration of therapeutic levels than on peak levels, frequent doses should be avoided. For instance, once- and three-times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis and to be less toxic to children’s kidneys. Similarly, a twice daily gentamicin dosing regimen has been proven neither less nephrotoxic nor more efficient than a once daily regimen in the treatment of infective endocarditis. The use of extended-interval (once daily) dosing for aminoglycosides is also effective and safe for immunocompromised patients with febrile neutropenia.
Supporting evidence
Buchholtz K; Larsen CT; Schaadt B; Hassager C; Bruun NE Once versus twice daily gentamicin dosing for infective endocarditis: a randomized clinical trial. Cardiology. 2011; 119(2):65-71
Levison ME, Levison JH. Pharmacokinetics and pharmacodynamics of antibacterial agents. Infect Dis Clin North Am. 2009;23(4):791–vii.
Smyth AR, Bhatt J, Nevitt SJ. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochrane Database Syst Rev. 2017;3(3):CD002009. Published 2017 Mar 27
Stabler SN, Ensom MH. Extended-interval aminoglycoside therapy for adult patients with febrile neutropenia: a systematic review. Can J Hosp Pharm. 2011 May;64(3):182-91
How this list was made
The Australian and New Zealand Society of Nephrology (ANZSN) Clinical Policy and Advisory Committee worked with the RACP, as part of the Evolve Program, to develop a long list of low-value practices and interventions that pertain to the specialty. Through extensive research and redrafting, the list was condensed to the top-5 recommendations for reducing low-value practices in nephrology. Dr David Tunnicliffe has been the Lead Fellow on the project.
The list of recommendations was then subject to an extensive review process that involved key College societies with an interest or professional engagement with nephrology as well as health equity. It was then further consulted with other medical colleges through Choosing Wisely Australia. Feedback received in the consultations led to further research and finetuning of the list, which was then finalised and approved by the ANZSN.
- 1 Do not give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single daily dose
- 2 Do not use oral acetylcysteine before giving radiocontrast to patients at increased risk for contrast-induced acute kidney injury
- 3 Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections
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4
Do not intensively lower HbA1C<6.5% to <8.0% in patients with early (stage 1-3) chronic kidney disease as intense lowering increases the risk of hypoglycaemia and mortality, noting that the individual target depends on factors such as severity of CKD, macrovascular complications, comorbidities, life expectancy and others
- 5 Do not prescribe aspirin therapy for primary prevention of cardiovascular disease in patients with stage 1-3 chronic kidney disease as there is no proven benefit and it is associated with increased risk of impaired haemostasis