Cefazolin and cephalexin kinetics in continuous ambulatory peritoneal dialysis

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Abstract
Singe-dose cefazolin (CFZ) and cephalexin (CPX) kinetics in continuous ambulatory peritoneal dialysis (CAPD) were studied to establish therapeutic guidelines for 2 cephalosporins commonly used to treat peritonitis in these patients, CFZ, 10 mg/kg, was given i.v. and i.p., while CPX, 500 mg, was given orally. CFZ led to serum concentrations of 25 .mu.g/ml at 24 h, with a half-life (t1/2) of 33 h. CAPD accounted for only 20% of total body clearance. When CFZ was given i.p., 74% of the dose was absorbed and similar serum concentrations had much the same t1/2. CPX had a serum t1/2 of 8.6 h and resulted in much lower peritoneal concentrations than CFZ. The kinetic principal of superposition provided a model for the prediction of plasma concentrations after repeated i.p. doses of CFZ. The model predicts that a 10 mg/kg i.p. loading dose, followed by 5 mg/kg doses in each exchange the first day and 2.5-mg/kg doses thereafter, will lead to steady-state plasma concentrations of 50-65 .mu.g/ml. CFZ evidently needs be given only i.p. at doses lower than those in current use. CPX probably adds little to the treatment of peritonitis.

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