Cefpodoxime proxetil in patients with endstage renal failure on hemodialysis

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.