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July 3, 1954, Vol 155, No. 10 >
ARTICLE | July 3, 1954

BACITRACIN NEPHROPATHY: Title and subTitle BreakREPORT OF A CASE OF ACUTE RENAL FAILURE AND DEATH FREE

Gabriel Genkins, M.D.; Jonathan W. Uhr, M.D.; Morton S. Bryer, M.D.
[+] Author Affiliations

New York

From the departments of pathology, medicine, and microbiology, Mt. Sinai Hospital.


JAMA. 1954;155(10):894-897. doi:10.1001/jama.1954.03690280018004
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References

Bacitracin, a polypeptide produced by Bacillus subtilis, was discovered in 1945 by Johnson, Anker, and Meleney.1 The early enthusiasm that followed the demonstration of its potent antibacterial action was soon dampened by reports of the nephrotoxic action of this and related polypeptide antibiotics2 both in experimental animals and in man.3

In nearly every reported case, clinicians observed transient urinary abnormalities when bacitracin therapy was extended over a few days. The resulting proteinuria, cylindruria, azotemia, and occasional oliguria usually were self-limited, but at times necessitated termination of therapy. A review of the literature fails to reveal any fatality attributed to this antibiotic, so that the description of the renal lesion in a human being is lacking.

The following case report is that of a patient with acute bacterial endocarditis. Renal failure unrelated to her primary disease developed in this woman after the institution of bacitracin therapy.

REPORT OF 

REFERENCES

1 +
Johnson, B. A.; Anker, H., and Meleney, F. L.:  Bacitracin: New Antibiotic Produced by Member of B. Subtilis Group , Science 102: 376, 1945;.
2 +
Brownlee, G.; Bushby, S. R. M., and Short, E. I.:  Pharmacology of Polymyxin A, B, and D , Ann. New York Acad. Sc. 51: 952, 1949;.
3 +
Michie, A. J.; Zintel, H. A.; Ravdin, I. S., and Ragni, M.:  Nephrotoxicity of Bacitracin in Man , Surgery 26: 626, 1949;.
4 +
Zintel, H. A.; Ma, R. A.; Nichols, A. C., and Ellis, H.:  Absorption, Distribution, Excretion and Toxicity of Bacitracin in Man , Am. J. M. Sc. 218:439, 1949;.
5 +
Meleney, F. L., and others:  Efficacy and Safety of Intramuscular Administration of Bacitracin in Various Types of Surgical and Certain Medical Infections, with Analysis of 270 Cases , Surg., Gynec. & Obst. 89: 657, 1949;.
6 +
Wallach, R., and Pomerantz, N.:  Combined Antibiotic Therapy: Report of Case of Subacute Bacterial Endocarditis Reinfected with Diphtheroid and Successfully Treated with Penicillin and Bacitracin , A. M. A. Arch. Int. Med. 88: 840 ( (Dec.) ) 1951;.
7 +
Volini, I. F., and Kadison, E. R.:  Simultaneous Bacitracin and Penicillin Therapy in Subacute Bacterial Endocarditis: Report of 3 Cases , Am. Pract. & Digest Treat. 2: 13, 1951;.
8 +
Miller, J. H.; McDonald, R. K., and Shock, N. W.:  Effect of Bacitracin on Renal Function , J. Clin. Invest. 29: 389, 1950;.
9 +
Wachstein, M.:  Nephrotoxic Action of dl-Serine in Rat: Localization of Renal Damage, Phosphatase Activity and Influence of Age, Sex, Time and Dose , Arch. Path. 43: 503 ( (May) ) 1947;.
10 +
Fishman, W. H., and Artom, C.:  Serine Injury , J. Biol. Chem. 145: 345, 1942;.
11 +
Artom, C.; Fishman, W. H., and Morehead, R. P.:  Relative Toxicity of l- and dl-Serine in Rats , Proc. Soc. Exper. Biol. & Med. 60: 284, 1945;.
12 +
Scudi, J. V., and Antopol, W.:  Some Pharmacological Characteristics of Bacitracin , Proc. Soc. Exper. Biol. & Med. 64: 503, 1947;.
13 +
Scudi, J. V.; Coret, I. A., and Antopol, W.:  Some Pharmacological Characteristics of Bacitracin: Chronic Toxicity Studies of Commercial Bacitracin in Dog and Monkey , Proc. Soc. Exper. Biol. & Med. 66: 558, 1947;.
14 +
Porath, J.:  Structure of Bacitracin A, abstracted , Nature , London 172: 871, 1953;.
15 +
Craig, L. C.; Hausmann, W., and Weisiger, J. R.:  Qualitative and Quantitative Amino Acid Content of Bacitracin A , J. Biol. Chem. 199: 865, 1952;.
16 +
McKinney, S. E., and others:  Benemid, p-(Di-n-propylsulfamyl)-Benzoic Acid: Toxicologic Properties , J. Pharmacol. & Exper. Therap. 102: 208, 1951;.
17 +
Beyer, K. H., and others:  'Benemid,' p-(Di-n-Propylsulfamyl)-Benzoic Acid: Its Renal Affinity and Its Elimination , Am. J. Physiol. 166: 625, 1951;.
18 +
 Probenecid, report of the Council on Pharmacy and Chemistry , J. A. M. A. 151: 298 ( (Jan. 24) ) 1953;.

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1 +
Johnson, B. A.; Anker, H., and Meleney, F. L.:  Bacitracin: New Antibiotic Produced by Member of B. Subtilis Group , Science 102: 376, 1945;.
2 +
Brownlee, G.; Bushby, S. R. M., and Short, E. I.:  Pharmacology of Polymyxin A, B, and D , Ann. New York Acad. Sc. 51: 952, 1949;.
3 +
Michie, A. J.; Zintel, H. A.; Ravdin, I. S., and Ragni, M.:  Nephrotoxicity of Bacitracin in Man , Surgery 26: 626, 1949;.
4 +
Zintel, H. A.; Ma, R. A.; Nichols, A. C., and Ellis, H.:  Absorption, Distribution, Excretion and Toxicity of Bacitracin in Man , Am. J. M. Sc. 218:439, 1949;.
5 +
Meleney, F. L., and others:  Efficacy and Safety of Intramuscular Administration of Bacitracin in Various Types of Surgical and Certain Medical Infections, with Analysis of 270 Cases , Surg., Gynec. & Obst. 89: 657, 1949;.
6 +
Wallach, R., and Pomerantz, N.:  Combined Antibiotic Therapy: Report of Case of Subacute Bacterial Endocarditis Reinfected with Diphtheroid and Successfully Treated with Penicillin and Bacitracin , A. M. A. Arch. Int. Med. 88: 840 ( (Dec.) ) 1951;.
7 +
Volini, I. F., and Kadison, E. R.:  Simultaneous Bacitracin and Penicillin Therapy in Subacute Bacterial Endocarditis: Report of 3 Cases , Am. Pract. & Digest Treat. 2: 13, 1951;.
8 +
Miller, J. H.; McDonald, R. K., and Shock, N. W.:  Effect of Bacitracin on Renal Function , J. Clin. Invest. 29: 389, 1950;.
9 +
Wachstein, M.:  Nephrotoxic Action of dl-Serine in Rat: Localization of Renal Damage, Phosphatase Activity and Influence of Age, Sex, Time and Dose , Arch. Path. 43: 503 ( (May) ) 1947;.
10 +
Fishman, W. H., and Artom, C.:  Serine Injury , J. Biol. Chem. 145: 345, 1942;.
11 +
Artom, C.; Fishman, W. H., and Morehead, R. P.:  Relative Toxicity of l- and dl-Serine in Rats , Proc. Soc. Exper. Biol. & Med. 60: 284, 1945;.
12 +
Scudi, J. V., and Antopol, W.:  Some Pharmacological Characteristics of Bacitracin , Proc. Soc. Exper. Biol. & Med. 64: 503, 1947;.
13 +
Scudi, J. V.; Coret, I. A., and Antopol, W.:  Some Pharmacological Characteristics of Bacitracin: Chronic Toxicity Studies of Commercial Bacitracin in Dog and Monkey , Proc. Soc. Exper. Biol. & Med. 66: 558, 1947;.
14 +
Porath, J.:  Structure of Bacitracin A, abstracted , Nature , London 172: 871, 1953;.
15 +
Craig, L. C.; Hausmann, W., and Weisiger, J. R.:  Qualitative and Quantitative Amino Acid Content of Bacitracin A , J. Biol. Chem. 199: 865, 1952;.
16 +
McKinney, S. E., and others:  Benemid, p-(Di-n-propylsulfamyl)-Benzoic Acid: Toxicologic Properties , J. Pharmacol. & Exper. Therap. 102: 208, 1951;.
17 +
Beyer, K. H., and others:  'Benemid,' p-(Di-n-Propylsulfamyl)-Benzoic Acid: Its Renal Affinity and Its Elimination , Am. J. Physiol. 166: 625, 1951;.
18 +
 Probenecid, report of the Council on Pharmacy and Chemistry , J. A. M. A. 151: 298 ( (Jan. 24) ) 1953;.

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