Cefazolin as empiric therapy in hemodialysis-related infections: Efficacy and blood concentrations

被引:41
作者
Marx, MA
Frye, RF
Matzke, GR
Golper, TA
机构
[1] Univ Arkansas Med Sci, Dept Med, Div Nephrol, Coll Pharm, Little Rock, AR 72205 USA
[2] Univ Arkansas Med Sci, Coll Pharm, Dept Pharm Practice, Little Rock, AR 72205 USA
[3] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA USA
[4] Univ Pittsburgh, Sch Pharm, Dept Pharmaceut Sci, Renal & Electrolyte Div, Pittsburgh, PA USA
关键词
cefazolin; empiric drug therapy; antibiotic resistance; hemodialysis infections;
D O I
10.1053/ajkd.1998.v32.pm9740156
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Concern about the increasing incidence of vancomycin-resistant organisms has tempered the enthusiasm for indiscriminate vancomycin use. Cefazolin has an antibacterial activity profile similar to vancomycin against most pathogens encountered in the hemodialysis (HD) population. We evaluated the clinical efficacy and serum concentrations that were achieved during empiric cefazolin use. Fifteen consecutive HD patients (five, conventional HD; five, high-efficiency HD; and five, high-flux HD) with suspected or documented infections warranting antibiotic intervention, including access-related, respiratory tract, urinary tract, or wound infections, were enrolled. Each patient received intravenous cefazolin (20 mg/kg actual body weight rounded to the nearest 500-mg increment [range, 1 to 2 g]) after each dialysis treatment for at least three doses. Cefazolin concentrations were obtained before and immediately after the next three consecutive dialysis treatments. Thirteen patients were evaluated for efficacy and all 15 were evaluated for toxicity and cefazolin blood concentrations. All patients showed at least a short-term (3-week) clinical resolution of infection with cefazolin treatment. No central nervous system toxicities were noted and no other adverse events were expressed by the patients during the course of cefazolin treatment. Predialysis cefazolin concentrations, as determined by high-performance liquid chromatography, were 70.2 +/- 42.7 (conventional HD), 45.6 +/- 18.9 (high-efficiency HD), and 41.6 +/- 23.9 mg/L (high-flux HD) over the three dialysis sessions. Cefazolin at doses of approximately 20 mg/kg administered post-ND appears to be a safe and effective empiric therapy and yields predialysis cefazolin concentrations of 2.5 times or greater than those considered to be the minimum inhibitory concentration breakpoint (16 mg/L) for susceptible organisms. These data support the broader use of cefazolin for empiric treatment in the HD population, allowing vancomycin to be reserved for confirmed resistant organisms. (C) 1998 by the National Kidney Foundation, Inc.
引用
收藏
页码:410 / 414
页数:5
相关论文
共 20 条
[1]  
[Anonymous], 1995, MMWR Recomm Rep, V44, P1
[2]   SEIZURES ASSOCIATED WITH HIGH CEREBROSPINAL-FLUID CONCENTRATIONS OF CEFAZOLIN [J].
BECHTEL, TP ;
SLAUGHTER, RL ;
MOORE, TD .
AMERICAN JOURNAL OF HOSPITAL PHARMACY, 1980, 37 (02) :271-273
[3]  
BROGARD JM, 1977, J CLIN PHARMACOL, V4, P225
[4]  
*CDC, 1997, MMWR-MORBID MORTAL W, V46, P624
[5]  
*CDC, 1997, MMWR-MORBID MORTAL W, V46, P765
[6]  
*CDC, 1997, MMWR-MORBID MORTAL W, V46, P626
[7]   PHARMACOLOGY OF CEFAZOLIN AND OTHER CEPHALOSPORINS IN PATIENTS WITH RENAL-INSUFFICIENCY [J].
CRAIG, WA ;
WELLING, PG ;
JACKSON, TC ;
KUNIN, CM .
JOURNAL OF INFECTIOUS DISEASES, 1973, 128 :S347-S353
[8]   Vancomycin resistance: When failure becomes an opportunity for leadership [J].
Edmiston, CE .
ANNALS OF PHARMACOTHERAPY, 1996, 30 (06) :680-682
[9]   Vancomycin-resistant Staphylococcus aureus: Perspectives on measures needed for control [J].
Edmond, MB ;
Wenzel, RP ;
Pasculle, AW .
ANNALS OF INTERNAL MEDICINE, 1996, 124 (03) :329-334
[10]   Vancomycin-resistant enterococci [J].
Gin, AS ;
Zhanel, GG .
ANNALS OF PHARMACOTHERAPY, 1996, 30 (06) :615-624