Determination of plasma and renal clearance of cefuroxime and its pharmokinetics in renal insufficiency

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Abstract
The pharmacokinetics of cefuroxime were investigated in 15 patients with various degrees of renal insufficiency. Ten patients were given single i.v. bolus injections; a further 5 patients were undergoing prolonged i.v. treatment and one of these was studied in both the anuric and polyuric phases of acute tubular necrosis. It is concluded that cefuroxime is eliminated almost completely by the kidneys in patients with normal renal function: both glomerular filtration and tubular secretion contribute. In patients with creatinine clearances below 40 ml/min only glomerular filtration may be left. The renal clearance of cefuroxime correlates well with urine flow and creatinine clearance in normal as well as in impaired renal function. As renal impairment increases non-renal mechanisms of elimination become more important. Haemodialysis is very effective in eliminating cefuroxime. A dosage schedule for cefuroxime treatment in patients with various degrees of renal insufficiency is proposed.