PERSISTENCE OF ANTIBIOTICS IN BLOOD OF PATIENTS WITH ACUTE RENAL FAILURE. III. PENICILLIN, STREPTOMYCIN, ERYTHROMYCIN AND KANAMYCIN*†

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Abstract
The serum half-life of penicillin was prolonged from about one-half hour in normal subjects to 7-10 hours in anuric patients falling to 4-7 hours during the early phase of recovery from acute renal failure. The role of the liver in the inactivation of penicillin was studied in 2 anuric patients who also had severe liver disease; the serum half-life in these patients was prolonged to 16.4 and 30.5 hours, respectively, suggesting that in the uremic patient, the liver may account for much of the degradation of the drug. The half-life of streptomycin in the serum of anuric patients was found to be 2-5 days, falling to 1-2 days during diuresis. In one patient who became progressively uremic and subsequently died of acute renal tublar nacrosis, streptomycin was still detectable 20 days after the last dose. The serum half-life of erythromycin was slightly prolonged from 155 hours in normal subjects to about 5 hours in 3 anuric patients. The presence of liver disease in one patient did not appear to prolong the serum half-life of erythromycin. The serum half-life of Kanamycin in 2 normal subjects was about 4 hours. Elevated levels of kanamycin were detectable in the blood of 2 severely uremic patients as long as 4-5 days following a single injection of 1.0 g. A theoretical analysis of the effect of changing renal function on the serum half-life of antibiotics is presented; this may be applicable to other drugs as well.