NEPHROTOXICITY OF CEFOTAXIME

799

pened earlier.

There is some evidence from animal studies that mianserin facilitates EEG seizure activity, and, on balance, we feel it was most likely to be responsible for the epileptic seizure in this patient. 14 other cases of convulsions associated with mianserin treatment have been reported to the Committee on Safety of Medicines. Although further evidence is needed before mianserin can definitely be said to be epileptogenic, caution is necessary when prescribing it for patients with a history of seizures. Department of Psychiatry, University of Southampton, Royal South Hants Hospital, Southampton SO9 4PE

P. TYRER B. STEINBERG B. WATSON

MIANSERIN

SiR,-In your editorial on poisoning with tricyclic antidepressants prescribed for enuresis in children (Sept. 8, p. 511) you state, incorrectly, that mianserin is a tricyclic. antidepresMianserin is a true tetracyclic piperazino-azepine comunlike the tricyclics, possesses no anticholinergic side-effects.l For this reason I would not recommend its use in treating enuresis. sant.

pound and,

Organon Laboratories, Ltd, Morden, Surrey SM4 5DZ

**Point taken-though

WILLIAM L. SHAW we

were

not

advocating

use

of

Fig. 2-AAP activity in 24-h during and after gentamicin.

urine and urine volume

before,

mianserin in enuresis.-ED. L.

aged

given gentamicin (3 mg/kg/d)

21-34 y

2) according

to

rose

sharply (fig. kidney

the accumulation of gentamicin in the

cortex.3 NEPHROTOXICITY OF CEFOTAXIME

SIR,-We have measured the elimination of alanine-aminopeptidase (AAP), a constituent of the brush border,2 in 24-h urines from 8 informed healthy volunteers (4 men, 4 women) two days before giving cefotaxime (3 g twice per day), on each day of the three-day course, and on the four subsequent days. Cefotaxime (HR 756) did not alter AAP elimination (fig. 1) and serum creatinine and creatinine clearance on days 1,3, and 7 remained normal. In contrast, the AAP activity in 24-h urines from 5 female and 10 male normal healthy volunteers 8. Peet M, Behagel H. Mianserin: Pharmacol 1978; 5: 5-9S.

a

decade of scientific

development. Br J Clin

1. Kopera H. Br J Clin Pharmacol 1978; 5: 29-345. 2. Mondorf AW, Breier J, Hendus J, Scherberich JE, Mackenrodt G, Shah PM, Stille W, Schoeppe W. The effect of aminoglycosides on proximal tubular membranes of the human kidney. Europ J Clin Pharmacol 1978; 13:

133-42.

Centre for Internal Medicine,

University of Frankfurt, 6000 Frankfurt 70, West

A. W. MONDORF

Germany

NITROFURANTOIN LUNG IN A CHILD disease associated with nitrofurantoin treatin adults has been reportedl but we know of only one such incident in a child.2 For this reason we wish to report the

SIR,-Lung

ment

following case. A 7-year-old, previously healthy, farmer’s daughter had a urinary-tract infection in February, 1977. She was treated with co-trimoxazole and then with nitrofurantoin. In March, 1977, the urine was sterile and therapy was discontinued. In September, 1977, infection recurred. Nitrofurantoin therapy was resumed at a dose of 20 mg twice daily (2 mg/kg/day). In November the urine was sterile and a micturating cystogram showed reflux up to the right renal pelvis. Chemoprophylaxis was started with 20 mg nitrofurantoin daily uninterrupted until March, 1979. In March, 1979, the patient had a cough and felt tired. Her breathing was short and noisy. She was admitted to hospital 2 or 3 weeks after the onset of the symptoms. There was no fever. The girl was thin, exhausted, and dyspnceic, with diffuse rales over both lungs. No signs of cardiac insufficiency or infection were noted. The chest X-ray showed bilateral, diffuse, intense, interstitial, partly spotty infiltration, and slight subpleural oedema. In the lung apexes there was a small pneumothorax which disappeared spontaneously in 2 3. Mondorf AW, Zegelman M, Klose J, Maske L, Scherberich JE, Stefanescu T, Müller H, Schoeppe W. Effects of various cephalosporins on the proximal tubule of the human kidney. Europ J Clin Pharmacol 1978; 13: 357-63. 1. Elmes PC. Antibacterial drugs used in miscellaneous infections. In: Dukes MNG, ed. Meyler’s side effects of drugs vol 8. Amsterdam: Excerpta

Fig. t—AAI* activity

in 24-h urine and urine volume before, during and after cefotaxime.

Medica, 668-69. RB, Andersen HA, Stickler

2. David

child with chronic 116: 418. a

CB. Nitrofurantoin

inflammatory lung

sensitivity: report of disease. Am J Dis Child 1968;