Pharmacokinetic Disposition of Cefonicid in Patients with Renal Failure and Receiving Hemodialysis

Cefonicid is a new cephalosporin with a spectrum of activity similar to that of cefamandole. The pharmacokinetic disposition of the drug was examined in patients with various degrees of renal dysfunction and who were receiving hemodialysis. After patients were given a 7.5 mg/kg dose as an iv infusion, multiple blood and urine samples were obtained at frequent intervals, and the samples were analyzed for cefonicid concentration. Five patients receiving hemodialysis received an additional dose before a dialysis period to assess removal of the drug. The half-life of cefonicid increased markedly with declining renal function (approximately 70 hr in anuric patients). Total clearance and renal clearance decreased linearly with decreases in creatinine clearance. Steady-state volume of distribution remained approximately the same (0.11 liter/kg) in all patients. Cefonicid dosage can be reduced in proportion to decreases in creatinine clearance from normal levels. A simple nomogram is provided.