Effect of total and partial nephrectomy on the elimination of ciprofloxacin in humans

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BackgroundRenal cell carcinoma (RCC) is the most common form of kidney cancer. Surgery is a standard procedure to resect the tumor during total (TN) or partial (nephron-sparing) nephrectomy (PN). Ciprofloxacin is most often administered at the usual intravenous dose of 100–400mg/12h. The application of such low doses of ciprofloxacin as 200mg/24h carries the risk of achieving subtherapeutic concentrations even in patients with limited renal function. The aim of the study was a comparison of concentrations and pharmacokinetics for ciprofloxacin at steady-state in patients after total and partial nephrectomy and evaluation of the effectiveness of the iv dose 200mg/24h against the theoretical value of MIC, 0.5μg/ml. MethodsThe research was carried out on two groups of patients after nephrectomy: total (group 1, n=21; mean [SD], age, 62.9 [14.4] years; weight, 76.0 [14.6]kg; creatinine clearance, clcr, 90.7 [22.2]ml/min) and partial (group 2, n=15; 61.7 [9.3] years; 87.8 [16.4]kg; CLCR, 107.8 [36.4]ml/min). The patients were treated with ciprofloxacin in the dose of 200mg/24h (iv). Plasma concentrations of ciprofloxacin at steady state were measured with validated HPLC method with UV detection. ResultsThe mean values of plasma concentrations of ciprofloxacin at steady state in group 1 and 2 were: Cssmax, 2.012 and 1.345; Cssmin, 0.437 and 0.244μg/ml, respectively. The main pharmacokinetic parameters for ciprofloxacin in group 1 and 2 were as follows: AUC(0–last), 30.9 [17.9] and 19.5 [8.7]μgh/ml; AUMC(0–last), 177.91 [11.1] and 91.9 [66.5]μgh2/ml; t1/2β, 13.9 [7.7] and 9.8 [3.3]h; MRT, 16.5 [12.1] and 9.77 [5.4]h; Vd, 115.0 [67.2] and 142.2 [78.7]l; CL, 6.2 [3.3] and 10.8 [5.7]l/h, respectively. With the assumed MIC=0.5μg/ml, the values of Cssmax/MIC<10 and AUC/MIC<125 were obtained in all the patients. ConclusionIn our patients we observed significant differences in some pharmacokinetic parameters of ciprofloxacin after two types of nephrectomy.