Ceftizoxime Dosing in Chronic Kidney Disease
For patients with chronic kidney disease (CKD), ceftizoxime dosing should be adjusted based on creatinine clearance, with an initial loading dose of 500 mg-1 gram followed by maintenance doses determined by the degree of renal impairment. 1
Dosing Guidelines Based on Renal Function
Normal Renal Function
- Standard adult dosing: 1-2 grams every 8-12 hours IV or IM 1
- For severe infections: Up to 2 grams every 4 hours in life-threatening cases 1
Impaired Renal Function
After an initial loading dose of 500 mg-1 gram IV or IM, adjust maintenance dosing as follows:
- Creatinine clearance >100 mL/min: No adjustment needed (standard dosing) 1, 2
- Creatinine clearance 61-99 mL/min: No significant adjustment needed 1, 2
- Creatinine clearance 31-60 mL/min: Extend dosing interval or reduce dose 1, 2
- Creatinine clearance 15-30 mL/min: Significant adjustment required - extend dosing interval to 12-24 hours 1, 2
- Creatinine clearance <10 mL/min: Extend dosing interval to 24-36 hours 1, 3
Hemodialysis Considerations
- No additional supplemental dosing is required following hemodialysis 1
- Timing is important: Dose should be administered at the end of the dialysis session 1
- This approach ensures adequate drug levels while preventing accumulation 2
Peritoneal Dialysis Considerations
- Ceftizoxime is partly eliminated by peritoneal dialysis with a clearance of approximately 2.9 ± 1.0 mL/min 3
- The absorption percentage of ceftizoxime from peritoneal dialysate is high (90.4 ± 7.0%) 3
- Patients on continuous ambulatory peritoneal dialysis have significantly prolonged half-life (T1/2 β = 16.9 ± 4.5 h) compared to normal renal function 3
Pharmacokinetic Considerations
- Ceftizoxime elimination half-life increases significantly in renal impairment 2, 3
- Drug clearance and elimination rate constant are reduced in patients with renal impairment 2
- Proper dosing adjustments maintain similar minimum plasma concentrations (Cmin) across different renal function groups 2
- Time above MIC (T>MIC) can be maintained at effective levels with appropriate dosing adjustments 2
Calculating Renal Function
When only serum creatinine is available, creatinine clearance can be calculated using:
- For males: CLcr = [Weight (kg) × (140 - age)] / [72 × serum creatinine (mg/100 mL)] 1
- For females: Multiply the above result by 0.85 1
Clinical Pearls and Caveats
- Always use the most recent creatinine value that represents steady-state renal function 1
- Pharmacodynamic parameters (T>MIC) should be considered alongside pharmacokinetic adjustments 2
- Drug dosing errors are common in patients with renal impairment and can lead to adverse effects 4
- Electronic calculators should be used when possible to ensure accurate dosing calculations 4
- Standardized approaches to dosing adjustments help prevent inconsistencies in drug exposure 5