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Pharmacokinetics of cefpirome during continuous venovenous hemofiltration: Rationale for an 8‐hour dosing interval
Author(s) -
Banyai Martin,
Thalhammer Florian,
El Menyawi Ibrahim,
Heinz Gottfried,
Traunmüller Friederike,
Siostrzonek Peter
Publication year - 2000
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1067/mcp.2000.105352
Subject(s) - cefpirome , pharmacokinetics , hemofiltration , medicine , pharmacology , cephalosporin , dosing , antibiotics , chemistry , hemodialysis , imipenem , biochemistry , antibiotic resistance
Objective Cefpirome is a new semisynthetic cephalosporin, primarily eliminated by the kidneys, that requires dosage adjustment in patients with kidney failure. The optimal dosing regimen of cefpirome in patients with continuous veno‐venous hemofiltration (CVVH) is unknown. Methods Pharmacokinetic properties of cefpirome were investigated in eight anuric patients with acute kidney failure treated by CVVH. All patients received a dosage of 2 g cefpirome every 8 hours after starting the hemofiltration with high‐flux polysulfone membranes. Concentrations of cefpirome in plasma and ultrafiltrate were measured by HPLC. Results Total clearance and hemofiltration clearance of cefpirome were 589.1 ± 164.5 mL/min and 43.3 ± 7.8 mL/min, respectively. Serum elimination half‐life was 2.36 ± 0.59 hours. The highest plasma drug concentration was 14.8 ± 3.2 μg/mL, and it declined to trough levels of 3.1 ± 0.8 μg/mL at the end of the dosing interval. Conclusion On the basis of previously published pharmacodynamic characteristics of cefpirome and the pharmacokinetic parameters obtained in this study, we calculated a required total daily dose of 2 g every 8 hours to achieve sufficient plasma antibiotic levels to cover the majority of target pathogens. However, this dosage may be insufficient during CVVH for intermediate resistant strains of Pseudomonas aeruginosa. (Clin Pharmacol Ther 2000;67:368‐72.) Clinical Pharmacology & Therapeutics (2000) 67 , 368–372; doi: 10.1067/mcp.2000.105352