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Pharmacokinetics of cloxacillin in patients undergoing hip or knee replacement
E Vinge1, G Nergelius, L G Nilsson
1Department of Clinical Pharmacology, University Hospital, Lund, Sweden.
Objective:
The pharmacokinetics of cloxacillin was investigated in 14 men and 24 women undergoing cemented hip (n = 19; age range 56-90) or knee replacement surgery (n = 19; age range 51-84) for osteoarthritis. Cloaxacillin 1 g was given intravenously as a bolus dose at the induction of anesthesia, and plasma samples and urine were collected for 6 h. Drug levels were determined using HPLC.
Results:
Preoperative serum creatinine levels were 84 mumol.l-1 in hip patients and 72 mumol.l-1 in knee patients. The calculated values for creatinine clearance were 63 and 85 ml.min-1.1.73 m-2, respectively. Total clearance of cloxacillin was 134 ml.min-1.1.73 m-2 in eighteen evaluated patients undergoing hip replacement, and 162 ml.min-1.1.73 m-2 in eighteen patients undergoing knee surgery. Renal clearance was 72 and 79 ml.min-1.1.73 m-2, respectively. Non-renal clearance was 57 ml.min-1.1.73 m-2 in hip patients and 77 ml.min-1.1.73 m-2 in knee patients. Renal clearance of cloxacillin correlated with the estimated creatinine clearance (r = 0.652). Although women received higher doses than men (median 2.02 vs 2.32 mmol.1.73 m-2), there were no sex differences in clearance corrected for body surface area.
Conclusion:
Total clearance of cloxacillin was lower in patients undergoing hip replacement than in patients undergoing replacement of the knee, but there was no difference between men and women.