Cefuroxime pharmacokinetics in continuous and intermittent peritoneal dialysis.

Pharmacokinetics of cefuroxime was studied in patients on continuous ambulatory or intermittent peritoneal dialysis. A single intravenous bolus (15 mg/kg) of cefuroxime provided a mean serum concentration of 86 mg/litre 5 min, 40 mg/litre 1 h, 163 mg/litre 24 h after the injection. The peritoneal clearance of cefuroxime varied widely among different individuals, ranging from 1.45 to 6.17 ml/min with a mean of 3.59 ml/min during 4-hour exchanges, and from 0,52 to 11.3 ml/min during 2-hour exchanges. A single injection (15 mg/kg) of the antibiotic could not provide satisfactory antibiotic concentrations in peritoneal effluent during peritoneal lavage. When cefuroxime had been added to peritoneal dialysis solution before the solution was instilled into the peritoneal cavity, a significant decrease in cefuroxime concentration occurred in the peritoneal effluent even after a short equilibration time. Furthermore, cefuroxime concentrations measured in residual dialysis solutions in the plastic bags ranged from 44.3 to 1,351% of the concentration of cefuroxime calculated from the added doses, indicating that despite great care, mixing of the antibiotic with dialysis solutions in plastic bags was far from uniform.

Excretion of cefuroxime in biliary disease.

Cefuroxime is a broad spectrum B-lactamase stable cephalosporin antibiotic. An intravenous injection of cefuroxime sodium 1.5 grams was administered to 45 patients after induction of anesthesia for cholecystectomy. Twenty-five patients had elective operations for chronic cholecystitis and 20 underwent urgent operations for acute cholecystitis. Of the 25 patients who underwent elective treatment, the cystic duct was patent in 13 and obstructed in 12. Antibiotic concentrations were measured by microbiologic assay in plasma, common bile duct bile, gallbladder bile and gallbladder wall. Organisms grown from the bile (Escherischia coli, eight; Proteus morganii, one; Streptococcus species, three, and Staphylococcus aureus, one) were sensitive to cefuroxime with the exception of one instance of Streptococcus faecalis. Cefuroxime levels were the same in specimens of patients with chronic or acute cholecystitis and reached therapeutic levels in the gallbladder wall, the main site of the inflammatory reaction. There was no difference in bile levels from gallbladders with patent or obstructed cystic ducts, suggesting that cefuroxime diffuses into the gallbladder and bile from the blood stream. There were no wound infections in this study when only a single dosage of antibiotic was administered intravenously.

Cefuroxime: potential use in pregnant women at term.

The placental transfer of cefuroxime was studied in 20 women after one or more 1.5 g intravenous injections. Ten women had labour induced at term and ten were delivered by elective Caesarean section. High concentrations of cefuroxime were found in the cord blood and amniotic fluid and therapeutically active antibiotic levels were found in the infants for up to six hours after delivery.

The efficacy of twice daily cephalexin.

A multi-centre study in general practice was carried out to compare the efficacy of two doses of cephalexin-500 mg or 1 g - given in a twice daily dosage regimen to 752 patients with respiratory or soft tissue infections. After 5-days' treatment, over 80% of the patients were cured or considerably improved, with no differences between the two treatment groups. Considering the lower respiratory and soft tissue infections together, 1 g cephalexin twice daily produced a better clinical response after 48-hours' treatment, suggesting a more rapid response with the higher dosage, but this trend did not reach statistical significance. Twice daily cephalexin therapy was also effective in patients with concurrent illness, and in those patients who had been treated unsuccessfully with other antibacterial therapy in the week prior to trial entry. No drug interactions were reported and the incidence of side-effects was low.

Cephalexin therapy for infections in the elderly and other vulnerable patients.

A multicentre study was carried out in general practice to investigate the efficacy, safety and tolerance of cephalexin in the treatment of infections in 194 patients with an underlying chronic disease or other complications, and in patients over the age of 65 years. For comparison, a group of 145 patients with no such complicating conditions was included in the study. Altogether, 339 patients were treated with doses of 1 g or 2 g cephalexin daily depending on the type and severity of infection. After treatment for 5 days, over 80% of patients were cured or much improved, with no differences between the two groups. Of the 95 patients who received 10-days' treatment, the clinical outcome was considered satisfactory in approximately 80% in both groups. No clinically significant biochemical changes were recorded, no drug interactions with concurrent therapy were reported, and the incidence of side-effects was low.