A Rare Case Series on Cefoperazone Sulbactam Induced Uremia: A Matter of Concern and Awareness

Uraemia is a clinical syndrome marked by elevated concentrations of urea in the blood and is associated with fluid, electrolyte, hormone imbalances and metabolic abnormalities. Cefoperazone + sulbactam is a combination of two medicines: cefoperazone and sulbactam. Cefoperazone is an antibiotic that works by preventing the formation of the bacterial protective covering, which is essential for the survival of bacteria [1]. Sulbactam is a beta-lactamase inhibitor that reduces resistance and enhances the activity of cefoperazone against bacteria [2].

Pharmaceutical agents play a central role in diagnostic and therapeutic activities for patient care. However, all agents carry the risk of adverse drug effects. While most of these are clinically insignificant, some drugs may cause unacceptable toxicity that negatively impacts patient morbidity and mortality [3]. Recognizing adverse effects is important for administering appropriate drug doses, implementing preventive strategies, and discontinuing the offending agent when toxicity occurs [2]. In most cases, nephrotoxicity leads to discontinuation of the causative drug, thereby limiting treatment options.

One of the biggest challenges lies in our ability to identify nephrotoxicity in its early stages. Monitoring serum creatinine and blood urea nitrogen (BUN) levels is an effective method for identifying renal diseases [4]. In this study, the authors report three cases of isolated cefoperazone-sulbactam-induced uraemia in patients without chronic kidney disease (CKD). A Naranjo assessment score of 5 was obtained for the three case scenarios, indicating a probable relationship between the patient’s uraemia and use of the suspected drug.