Pharmacokinetics of intravenous and intraperitoneal cefuroxime in patients undergoing peritoneal dialysis

The pharmacokinetics of cefuroxime sodium, a parenteral beta-lactam antibiotic, were investigated in 9 patients during peritoneal dialysis. In 6 patients cefuroxime 500 mg was administered intravenously. Mean plasma levels of cefuroxime thereafter fell from 28.0 +/- 5.0 mg/l at 1 hr to 6.0 +/- 1.6 mg/l at 24 hr. Mean peak levels 4.6 +/- 1.9 mg/l in peritoneal effluent were found 7 hr after dosing and clearance of the drug by peritoneal dialysis averaged 4.7 ml/min. There was no evidence of net tubular secretion or of increased non-renal elimination. In 5 patients, the administration of cefuroxime, 100 mg/2 l dialyzate, in each cycle of dialysis maintained mean cefuroxime levels of 25.4 +/- 13 mg/l in the dialysis effluent. An average of 44% of the dose was not recovered in the effluent, and was presumably absorbed by the patient, and mean plasma levels of cefuroxime increased from 1.1 +/- 0.4 mg/l at 1 hr to 14.0 +/- 8.1 mg/l at 24 hr. If cefuroxime is used to treat peritoneal infections associated with peritoneal dialysis it should be given by both intraperitoneal and intravenous routes and followed up with parenteral therapy alone.