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D. Kuypers, J. Vanwalleghem, B. Maes, T. Messiaen, Y. Vanrenterghem, W. E. Peetermans, Cefazolin serum concentrations with fixed intravenous dosing in patients on chronic hemodialysis treatment, Nephrology Dialysis Transplantation, Volume 14, Issue 8, August 1999, Pages 2050–2051, https://doi.org/10.1093/ndt/14.8.2050
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Sir,
Staphylococcus aureus and coagulase-negative staphylococci are the most frequent causes of sepsis in chronic haemodialysis patients. Due to the emergence of vancomycin-resistant enterococci (VRE) and staphylococci, the use of vancomycin as empirical treatment for sepsis or because of dosing convenience in patients with renal failure has been discouraged. The spectrum of anti-bacterial activity of cefazolin, a first-generation cephalosporin, offers an attractive alternative for vancomycin (with or without aminoglycoside) as treatment for sepsis in patients on chronic haemodialysis, however data about cefazolin pharmacokinetics and efficacy in this population are sparse. Recently it was shown that a titrated dose of cefazolin 20 mg/kg given i.v. after dialysis was effective for achieving therapeutic serum concentrations with resolution of clinical infections [5].
We conducted a study with a fixed cefazolin dose of 2 g i.v. in our chronic haemodialysis patients to establish whether this more convenient dosing strategy would also be effective.
Methods. Fifteen stable chronic ambulatory haemodialysis patients from our low-care dialysis centre (14 male patients) gave informed consent to participate in the pharmacokinetic part of the study. They were free of infection for at least 4 weeks at the time of inclusion. Patients known to be allergic to penicillins or cephalosporins were excluded. Fourteen patients were on haemodialysis (4 h sessions) and one on haemodiafiltration (4 h sessions); 14 patients used high-flux membranes and the remaining one a medium-flux membrane. Patients age ranged from 41 to 77 years (mean 64.5 years); the mean body weight for this group was 72 kg (range 53–104 kg). Etiology of chronic renal insufficiency was diabetic nephropathy (two patients), chronic glomerulonephritis (four), adult dominant polycystic kidney disease (three), renal vascular disease (one) and unknown (five).
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