A reduction in serum aminoglycoside levels can occur if aminoglycosides and penicillins are given together to patients with severe renal impairment. Carbenicillin, piperacillin and ticarcillin have been implicated with both gentamicin and tobramycin. Netilmicin appears not to interact with piperacillin. No interaction of importance appears to occur either with intravenous aminoglycoside and penicillins in those with normal renal function, or between aminoglycosides and carbapenems.
In patients with renal impairment it has been recommended that the penicillin dosage should be adjusted according to renal function, and the serum levels of both antibacterials closely monitored. However, note that antibacterial inactivation can continue in the assay sample, and rapid assay is probably necessary. There would seem to be no reason for avoiding concurrent use in patients with normal
renal function because no significant in vivo inactivation appears to occur.
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