ArticleEuropean journal of clinical pharmacology2026
Examining the risk of neurotoxicity in patients who receive unadjusted doses of oral beta-lactams in renal insufficiency: a retrospective cohort study.
Article in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn patients with reduced renal function, drug monographs recommend reduced doses of oral beta-lactams. However, dose reductions could result in suboptimal pharmacokinetic-pharmacodynamic target attainment, compromising efficacy. This study evaluated the safety of full doses of oral beta-lactams in patients with reduced renal function by assessing the incidence of neurotoxic symptoms.
methodsThis single-site, retrospective cohort study included patients with renal insufficiency prescribed full dose or renally adjusted doses of oral beta-lactams. Neurotoxicity symptoms were graded via chart review using the Naranjo Adverse Drug Reaction Probability Scale. The primary outcome was incidence of 'probable' or 'definite' beta-lactam related neurotoxicity. Multivariate logistic regression was used to adjust for differences in baseline characteristics.
resultsThe cohort included 987 patients with renal insufficiency receiving 1001 full-dose courses and 122 renally adjusted dose courses. The rate of 'probable' or 'definite' neurotoxicity was 0.1% (1/1001) in the full dose group and 0.8% (1/122) in the renally adjusted group (p = 0.08). There was no difference between groups when stratified by early or late stage renal insufficiency. After adjustment for differences in baseline characteristics, receiving full dose oral beta-lactams was not associated with an increased odds of 'possible', 'probable' or 'definite' neurotoxicity as the aOR was less than 1 [aOR = 0.52, 95% CI 0.30-0.89, p = 0.02].
conclusionThere was no increase in 'probable' or 'definite' neurotoxicities detected among patients with renal insufficiency receiving full dose as compared to renally adjusted doses of oral beta-lactams, suggesting that using full doses are a safe way to optimize the pharmacokinetic-pharmacodynamic parameters of these drugs.
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