[Antibiotic therapy and renal insufficiency. Pharmacokinetics of pivampicillin, cephaloridin and streptomycin in chronic uremic patients undergoing conservative or hemodialytic treatment]

The plasma kinetics of some antibiotics (pivampicillin, cephaloridine, streptomycin) has been studied in patients with chronic renal failure. The oral administration of pivampicllin promptly increases the plasma levels of the antibiotic, without any toxic side effect: this antibiotic is to be chosen in chronic uremic patients, also during regular dialytic treatment (R.D.T.). Cephaloridine has some renal toxic effects in high concentration; in the renal failure it is advisable to calculate the exact dose of the antibiotic by the use of nomograms when the creatinine clearance is known. These nomograms must absolutely be employed when administrating some toxic antibiotics, as gentamycin and streptomycin in chronic uremic patients. Some formulas have been experimentally determined, which allow a calculation of the exact dose of the antibiotic, also during R.D.T. If a kidney or urinary tract infection is present in patients with low G.F.R. (creatinine-clearance less than 30 ml/min.), it is necessary to administer only those antibiotics which can reach an active urinary concentration (i.e. penicillin and derivatives, cephaloridine).