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Published in: Intensive Care Medicine 8/2020

01-08-2020 | Amoxicillin | Imaging in Intensive Care Medicine

Macroscopic amoxicillin crystalluria

Authors: E. Trillaud, I. Bendib, R. Arrestier, K. Razazi

Published in: Intensive Care Medicine | Issue 8/2020

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Excerpt

A 36-year-old woman was admitted in intensive care unit (ICU) for coma secondary to pneumococcal meningitis complicated by acute obstructive hydrocephalus requiring emergency external cerebrospinal fluid drainage. She weighed 100 kg. Dexamethasone and antimicrobial therapy (cefotaxime, 24 g/day) were started at ICU admission. After 36 h, cefotaxime was switched to amoxicillin (20 g/day administered in six infusions of 60 min) based on the bacterial minimum inhibitory concentration. 36 h later, the urine was white yellowish and turbid, with white particles in the urinary catheter (Fig. 1a) that sedimented in the urine collection recipient (Fig. 1b). Crystalluria was suspected and amoxicillin was switched back to cefotaxime, pending the result of plasmatic antibiotic concentrations. Microscopic urine examination confirmed a massive crystalluria with characteristic amoxicillin crystals (Fig. 1c), associated with microscopic hematuria and a urinary pH of 5.8. Amoxicillin trough concentration was 5.2 mg/l. Hydration and alkalization were initiated, and macroscopic crystalluria disappeared. The patient never developed acute renal failure (glomerular filtration rate of 110 mL/min/1.73 m2). She was extubated at day-6 and discharged from ICU at day-12.
Metadata
Title
Macroscopic amoxicillin crystalluria
Authors
E. Trillaud
I. Bendib
R. Arrestier
K. Razazi
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 8/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-020-05970-2

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