Which antibiotic can cause nephrotoxicity, especially when used with other nephrotoxic agents?

Aminoglycosides are well-known for their potential to cause nephrotoxicity, particularly when administered in conjunction with other nephrotoxic agents. This class of antibiotics includes drugs like gentamicin, tobramycin, and amikacin, which can lead to acute kidney injury, primarily by affecting the renal tubular cells. The nephrotoxic effects of aminoglycosides are dose-dependent and can be exacerbated by factors such as pre-existing renal impairment or concurrent use of other medications that have nephrotoxic properties, such as certain diuretics, vancomycin, or non-steroidal anti-inflammatory drugs (NSAIDs).

The mechanism of nephrotoxicity associated with aminoglycosides typically involves accumulation of the drug in renal tubular cells, leading to cellular damage and apoptosis. Clinicians often monitor serum drug levels and renal function closely during therapy to mitigate the risk of kidney injury.

While some of the other antibiotic classes listed may have side effects or specific toxicities, their association with nephrotoxicity is not as pronounced or as well established as it is with aminoglycosides.