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

Background: renal 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 100-400 mg/12 h. the application of such low doses of ciprofloxacin as 200 mg/24 h 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 200 mg/24 h against the theoretical value of mic,0.5 μg/ml. methods: the 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 200 mg/24 h (iv). plasma concentrations of ciprofloxacin at steady state were measured with validated hplc method with uv detection. results: the mean values of plasma concentrations of ciprofloxacin at steady state in group 1 and 2 were: css max,2.012 and 1.345; css min,0.437 and 0.244 μg/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] μg h/ml; aumc(0-last),177.91 [11.1] and 91.9 [66.5] μg h2/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 = 0.5 μg/ml,the values of css max/mic < 10 and auc/mic < 125 were obtained in all the patients. conclusion: in our patients we observed significant differences in some pharmacokinetic parameters of ciprofloxacin after two types of nephrectomy. copyright © 2012 by institute of pharmacology polish academy of sciences.