Cefoperazone [Ref: Goodman Gilman 17thie 1147, 1148; Katzung 10 p. 7371 Remember: ? Most cephalosporins are excreted mainly by tubular secretion. But ceftriaxone and cefoperazone are excreted mainly in bile and no dose adjustment is required in renal insufficiecy. The other unique feature of cefriaxone is its long half life. Thus it can be injected O.D. or B.D. in serious infections. According to Goodman and Gilman "All cephalosporins are excreted through kidney except celPiramide and cefoperazone which are excreted predominantly in the bile". About ceftriaxone Goodman Gilman mentions. "50% of this drug is excreted through urine while 50% of it is excreted through bile". But Katzung differs from Goodman Gilman "All cephalosporins are excreted through kidney except .for cefoperazone and ceftriaxone which are excreted mainly through the bilian' tract". Antimicrobial Drugs that do not require dosage adjustment in Renal Failure Cephalosporins Antitubercular * Cefoperaczone * Rifampicin * Ceftriaxone Other (miscellaneous) * Cefopiramide * Clindamycin * Chloramphenicol * Metronidazole Macrolides * Amphoterecin B * Erythomycin * Linezolid * Clarithomycin * Quinupristin / Dalfopristin * Azithromycin * Nafcillin / Oxacillin Fluoroquinolones Tetracycline * Trovafloxacin * Doxycycline * Grepafloxacin * Minocycline Use of Antimicrobial Agents in the Presence of Renal Dysfunction (Anesthesiology by Longnecker, Newman, Zapol'(2007J/285 Containdicated in the presence of dosage Require Require dosage adjustment only with severe adj adjustment with renal failures: renal failure: moderate renal failure: * Tetracyclines (except doxycycline), * Carbenicillin, ticarcillin, * Ampicillin, * Isoniazid, * Nitrofurantoin, * Cefazolin, * Mezlacillin. * Ethambutol, * Cephaloridine, * Aminoglycosides, * Piperacillin * Meropenem, * Long-acting sulfonamides, * Vancomycin, * Cefoxitin, * Nalidixic acid, * Methenamine, * Irnipenem, * Cefotaxime, * Ciprofloxacin, * Paraaminosalicylic acid * Flucytosine, * Penicillin G, * 5- fluorocytosine, * Fluconazole * Ceftizoxime, * Ofloxacin, * Ceftazidime, * Levofloxacin, * Cefuroxime, * Norfloxacin, * Cefotetan, * Itraconazole * Trimethoprim? * Sulfamethoxazole,