Cefoperazone for empiric therapy in patients with impaired renal function

Abstract

Thirty-five patients with serious infections and impaired renal function were treated empirically with 2 to 8 g of cefoperazone per day. Infections included sepsis in 14, nonbacteremic urinary infections in nine, pneumonia in five, intra-abdominal infection in five, fasciitis in one, and malignant otitis extema in one. The average age of this group was 64.3 years, 25 had ultimately fatal underlying diseases, and their average serum creatinine level was 5.2 mg/dl. Infections were caused by Enterobacteriaceae in 23 patients, Streptococcus faecalis in five, Pseudomonas aeruginosa in four, Staphylococcus aureus in four, Hemophilus influenzae in three, and Staphylococcus epidermidis, Streptococcus pneumoniae, and Clostridium sordelli in one each. Overall, 32 patients had clinical and microbiologic cures, two had improvement, and one had failure. Hypoprothrombinemia occurred in 18 of 28 patients not given vitamin K for prophylaxis and occurred more often in those with serum albumin concentrations below 3.5 g/dl. Prothrombin times returned to normal within 36 hours of treatment with vitamin K, although two patients experienced mild hematemesis. In anicteric patients with liver function abnormalities, 2 g every 12 hours produced peak and trough serum concentrations that averaged 254 and 125 μg/ml, respectively, compared with 179.5 and 19.5 μg/ml, respectively, in five with normal liver function test results. In jaundiced patients treated with 1 g every 12 hours, trough concentrations were comparably elevated. Serum concentrations did not correlate with hypoprothrombinemia, but high levels throughout the dosing interval may have contributed to the excellent cure rate in this study.