Uremia, Deafness, and Paralysis Due to Irrigating Antibiotic Solutions

Abstract

Prophylactic and therapeutic irrigation of body tissues with antibiotic-containing solutions is in widespread practice among physicians. The peritoneal cavity, pleural cavity, and orthopedic wounds are the most frequent sites of antibiotic instillation. The effectiveness of this practice has been described,1but a recent study has indicated that no benefit was obtained from antibiotic irrigation of orthopedic wounds.2This communication concerns the toxic manifestations in two patients whose orthopedic wounds were irrigated with a solution containing polymyxin B sulfate, neomycin sulfate, and bacitracin, and one patient whose wound was irrigated with a solution containing only neomycin. All three patients had reversible acute renal failure and all became clinically deaf. In addition, one patient had toxic effects to the nerves and muscles as manifested by postoperative muscular weakness and apnea. Hemodialysis was used in treatment of the toxic effects from these particular agents. Patient Summaries Patient 1. —An 18-year-old white