The blood levels of cefpodoxime of 16 hemodialysis patients were monitored after a single oral of Cefpodoxime proxetil with a Cefpodixime-equivalent of 200 mg dose. Eight patients were on dialysis during the period of observation, while the other eight patients were observed during a non-dialysis period. During hemodialysis the cefpodoxime levels were determined before and after the capillary dialyzer. It became apparent that hemodialysis patients have considerably higher and longer-lasting concentrations than patients with normal kidney function. The area under the curve is about seven times greater. Cefpodoxime is thus apparently eliminated to a great extent renally. The concentration levels before capillary dialyzer are noticeably higher than those after capillary dialyzer, so that it can be assumed that cefpodoxime is being dialyzed: the area under the curve of the eight patients observed during hemodialysis was about 50% less than that of the patients observed while not on hemodialysis. Based on the pharmacokinetic data gathered, simulations of the course of concentration were made which took into consideration the clinical circumstances (normal period of dosage administration and dialysis). According to these simulations one can recommend a loading dose of 200 mg and thereafter a dose of 100 mg 12 h later followed by 100 mg every 24 h. This will result in an average concentration of 2 mg/l and never falling below 1.5 mg/l. With this schedule all bacteria considered to be sensitive can be reached. Cefpodoxime proxetil thereby ensures a simple and effective therapy of bacterial infections in hemodialysis patients.

Administration, Oral↗

PubMedDate not supplied

Pharmacokinetics of teicoplanin in hemodialysis patients.

As only insufficient knowledge about the dosage of teicoplanin in hemodialysis patients exists, a clinical trial was performed on 26 patients. An initial dose of 800 mg teicoplanin, followed by doses of 400 mg on day 8 and day 15, was administered. In addition to the common clinical parameters (fever, white blood cell count, C-reactive protein), the plasma concentrations of this substance were determined. The HLTterm was 159 +/- 35 h, the Vss 104 +/- 25 1/100 kg and the CLtot 5.3 +/- 1.3 ml/min. It could be shown that the dosage regimen mentioned above produced long-lasting and highly effective levels, sufficiently surpassing the MICs of the expected bacteria (streptococci and staphylococci). The easily administered substance showed no adverse side effects, based on clinical criteria. The above-mentioned therapy nearly always resulted in success according to clinical criteria. Therefore, and due to its easy administration, it seems advantageous to start treatment with teicoplanin in hemodialysis patients obviously suffering from bacterial infections.

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PubMedDate not supplied

Pharmacokinetics of azithromycin in normal and impaired renal function.

Plasma and urine levels of 12 healthy subjects and 30 patients with renal insufficiency of different degrees were examined after oral administration of four 250 mg capsules azithromycin (total daily dose 1,000 mg). The concentrations were determined by cup plate method. The pharmacokinetic parameters were determined model-dependent and noncompartmentally. Neither the area under the plasma concentration curve nor the distribution volume in steady state (16 l/kg body weight) nor the maximal plasma concentration were significantly affected by renal insufficiency. Thus the dosage regimen of azithromycin in renal impairment may (and should) be the same as in patients with normal renal function. The nonrenal clearance is not affected by renal insufficiency, but the concentration of the substance in the tubular lumen (the "tubular load") may be increased.

Administration, Oral↗

PubMedDate not supplied

[Changes in pharmacokinetics in the aged and their practical consequences].

Liberation and absorption of drugs may be changed in elderly people. The distribution of water-soluble substances take place in a smaller, of fatty-soluble substances in a greater volume. According to the smaller GFR in elderly, the halflife-time of renally excreted drugs is prolonged. The pharmacokinetic changes in elderly are therefore multiple, and can hardly be predicted in the individual case. It seems important to use drugs with e white instead of a small therapeutic range (e. g. Penicillins, not Aminoglycosides). In some drugs (as diuretics, antihypertensives et al.) the effect and the side effects can judged clinically. In this drugs a strong clinically supervision of the patient is needed. Special attention in elderly patients should ly on the problem of compliance. In some special cases it is necessary to determine the plasma level.

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PubMedDate not supplied

[Pharmacokinetics of hydroxyethyl starch in kidney failure].

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