Absorption of antibiotics during peritoneal dialysis in patients with renal failure

Cloxacillin, ampicillin, cephaloridine, kanamycin, and polymyxin B were administered singly in the dialysis fluid of patients having peritoneal dialysis for chronic renal failure. Therapeutic blood levels could be attained with all the drugs by the end of 12 hours of dialysis, using a concentration in the dialysis fluid which did not produce any local toxic symptoms. Absorption rates across the peritoneum were higher for cephaloridine, ampicillin, and cloxacillin than for kanamycin and polymyxin B. The serum half-lives after termination of dialysis were in excess of 11 hours, except that for cloxacillin which had a half life of about 2.5 hours.

Excretion of cephaloridine and cephalothin in patients with renal impairment

Cephaloridine has been shown to possess certain favorable pharmacologic features while retaining the desirable antimicrobial properties of the parent compound, cephalothin. The major advantage of cephaloridine is its relatively greater resistance to metabolic degradation, presumably by the liver. This results in more prolonged blood levels in healthy subjects and a longer half-life in patients with severe renal disease. These features, together with reported enhanced antimicrobial activity and lack of inhibition by serum, suggest that it may replace or substitute for the parent compound, cephalothin, provided further clinical trials indicate that it proves to be an effective agent. Suggestions are given for a modified dosage schedule in uremic patients and during hemodialysis.