Cefonicid kinetics in subjects with normal and impaired renal function

Cefonicid is a cephalosporin with a longer t½ than currently available cephalosporins. Cefonicid kinetics after an intravenous dose of 7.5 mg/kg were followed in four groups of subjects: group 1, four subjects with normal creatinine clearance (Cl cr > 80 ml/min); group II, seven subjects with mild renal insufficiency (Cl cr 50 to 80 ml/min); group III, five subjects with moderate to severe renal impairment (Cl cr 8 to 49 ml/min); and group IV, five subjects with end‐stage renal disease who were receiving maintenance hemodialysis (Cl cr < 8 ml/ml). Cefonicid volume of distribution ranged from 6.9% to 17.6% body weight but was not related to Cl cr . Elimination t½ was 4.6 ± 0.7 hr in group I, 6.0 ± 2.7 hr in group II, 25.6 ± 14.0 hr in group III, and 65.3 ± 43.6 hr in group IV. There was a strong correlation between plasma cefonicid clearance and Cl cr . Nonrenal clearance did not change with decreasing Cl cr . Hemodialysis clearance calculated from plasma concentrations and recovery in dialysate was 2.5 ± 0.9 ml/min. These kinetic parameters were used to formulate dosage regimens for patients with renal impairment. Clinical Pharmacology and Therapeutics (1984) 35 , 798–803; doi: 10.1038/clpt.1984.115