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The metabolic disposition of flucloxacillin in patients with impaired kidney function

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Summary

The fate of flucloxacillin and its active metabolite hydroxyflucloxacillin was studied in a group of patients with impaired kidney function. Flucloxacillin was administered orally or intravenously. Peak levels of hydroxyflucloxacillin were obtained between 150 and 250 min after the administration of flucloxacillin. The plasma concentrations obtained after a therapeutic dose of flucloxacillin were well above the concentration (i.e. 1–2 µg/ml) generally considered to be the effective minimum for isoxalyl penicillins. The plasma half life of the metabolite was twice as long as that of flucloxacillin (295 min and 154 min, respectively). The nonprotein-bound fraction of hydroxyflucloxacillin in plasma from patients was twice as large as that of its parent compound (16.2 vs. 8.1%). This was also observed in normal human plasma, although protein binding in the latter was higher than in uraemic plasma. Some accumulation of hydroxyflucloxacillin may occur during flucloxacillin therapy with dosage intervals of 6 h.

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References

  1. Barza M, Weinstein L (1976) Pharmacokinetics of the penicillins in man. Clin Pharmacokinet 1: 297–308

    Google Scholar 

  2. Bird AE, Nayler JHC (1971) Design of penicillins. In: Ariëns EJ (ed) Drug design II. Academic Press, New York

    Google Scholar 

  3. Boobis SW (1977) Alteration of plasma albumin in relation to decreased drug binding in uremia. Clin Pharmacol Ther 22: 147–153

    Google Scholar 

  4. Cole M, Kenig MD, Hewitt VA (1973) Metabolism of penicillins to penicilloic acids and 6-aminopenicillanic acid in man and its significance in assessing penicillin absorption. Antimicrob Agents Chemother 3: 463–468

    Google Scholar 

  5. Craig WA, Welling PG (1977) Protein binding of antimicrobials: Clinical pharmacokinetics and therapeutic implications. Clin Pharmacokinet 2: 252–268

    Google Scholar 

  6. Dettli L (1977) Elimination kinetics and dosage adjustment of drugs in patients with kidney disease. Progr Pharmacol 1: 1–34

    Google Scholar 

  7. Dittert LW, Griffen WO, LaPiana JC, Shainfeld FJ, Doluisio JT (1970) Pharmacokinetic interpretation of penicillin levels in serum and urine after intravenous administration. Antimicrob Agents Chemother 1969: 42–48

    Google Scholar 

  8. Drayer DE (1976) Pharmacologically active drug metabolites: Therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure. Clin Pharmacokinet 1: 426–443

    Google Scholar 

  9. Fabre J, Balant L (1976) Renal failure, drug pharmacokinetics and drug action. Clin Pharmacokinet 1: 99–120

    Google Scholar 

  10. Fabre J, Fox HM, Dayer P, Balant L (1980) Differences in kinetic properties of drugs: implications as to the selection of particular drug for use in patients with renal failure with special emphasis on antibiotics and beta-adrenoceptor blocking agents. Clin Pharmacokinet 5: 441–464

    Google Scholar 

  11. Gerding DN, Peterson LR, Salomonson JK, Hall HW, Schierl EA (1978) Prediction of the concentration of penicillins in ascitic fluid from serum kinetics and protein binding of the antibiotics in serum and ascitic fluid of dogs. J Infect Dis 138: 166–173

    Google Scholar 

  12. Gibaldi M, McNamara P (1978) Apparent volumes of distribution and drug binding to plasma proteins and tissues. Eur J Clin Pharmacol 13: 373–378

    Google Scholar 

  13. Gibaldi M, Koup JR (1981) Pharmacokinetic concepts — Drug binding apparent volume of distribution and clearance. Eur J Clin Pharmacol 20: 299–305

    Google Scholar 

  14. Guerrero IC, MacGregor RR (1979) Comparative penetration of various cephalosporins into inflammatory exudate. Antimicrob Agents Chemother 15: 712–715

    Google Scholar 

  15. Hellström KA, Rósen A, Swahn A (1974) Fate of oral 35S-cloxacillin in man. Eur J Clin Pharmacol 7: 125–131

    Google Scholar 

  16. Kunin CM (1966) Clinical pharmacology of the new penicillins. I. The importance of serum protein binding in determining antimicrobial activity and concentration in serum. Clin Pharmacol Ther 7: 166–179

    Google Scholar 

  17. Kunin CM, Craig WA, Kornguth M, Monson R (1973) Influence of binding on the pharmacological activity of antibiotics. Ann NY Acad Sci 226: 214–224

    Google Scholar 

  18. Nauta EH, Mattie H, Goslings, WRO (1973) Pharmacokinetics of cloxacillin in patients on chronic intermittent haemodialysis and in healthy subjects. Chemotherapy 19: 261–271

    Google Scholar 

  19. Nauta EH, Mattie H (1975) Pharmacokinetics of flucloxacillin and cloxacillin in healthy subjects and patients on chronic intermittent haemodialysis. Br J Clin Pharmacol 2: 111–121

    Google Scholar 

  20. Nauta EH, Mattie H (1976) Dicloxacillin and cloxacillin: pharmacokinetics in healthy and hemodialysis subjects. Clin Pharmacol Ther 20: 98–108

    Google Scholar 

  21. Reidenberg MM (1976) The binding of drugs to plasma proteins from patients with poor renal function. Clin Pharmacokinet 1: 121–125

    Google Scholar 

  22. Reidenberg MM (1977) The biotransformation of drugs in renal failure. Am J Med 62: 482–485

    Google Scholar 

  23. Reidenberg MM, Drayer DE (1978) Effects of renal disease upon drug disposition. Drug Metab Rev 8: 293–302

    Google Scholar 

  24. Rolinson GN, Batchelor FR (1963) Penicillin metabolites. Antimicrob Agents Chemother 1962: 654–660

    Google Scholar 

  25. Tan JS, Salstrom SJ (1977) Levels of carbenicillin, ticarcillin, cephalothin, cefazolin, cefamandole, gentamicin, tobramycin, and amikacin in human serum and interstitial fluid. Antimicrob Agents Chemother 11: 698–700

    Google Scholar 

  26. Thijssen HHW, Mattie H (1976) Active metabolites of isoxazolyl-penicillins in humans. Antimicrob Agents Chemother 10: 441–446

    Google Scholar 

  27. Thijssen HHW (1980) Analysis of isoxazolyl penicillins and their metabolites in body fluids by high-performance liquid chromatography. J Chromatogr 183: 339–345

    Google Scholar 

  28. Tillement JP, Lhoste F, Guidicelli JF (1978) Diseases and drug protein binding. Clin Pharmacokinet 3: 144–154

    Google Scholar 

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Thijssen, H.H.W., Wolters, J. The metabolic disposition of flucloxacillin in patients with impaired kidney function. Eur J Clin Pharmacol 22, 429–434 (1982). https://doi.org/10.1007/BF00542548

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  • DOI: https://doi.org/10.1007/BF00542548

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