The disposition of cefmetazole was studied in 25 subjects with various degrees of renal function after a 1,000-mg, constant-rate, 30-min intravenous infusion of cefmetazole sodium. In six subjects with creatinine clearance (CLCR) of >90 m/min per 1.73 m2 (group 1), the terminal elimination half-life (t4123) was 1.31 0.54 h (mean + standard deviation), cefmetazole total body clearance (CLp) was 132.8 25.1 ml/min per 1.73 m2, and volume of distribution at steady state was 0.165 ± 0.025 liter/kg. The fraction of dose excreted unchanged in the urine was 84.0% ± 26.1%. Subjects with CLcRs of 40 to 69 (group 2, n = 6) and 10 to 39 (group 3, n -6) ml/min per 1.73 m2 demonstrated prolongation of the tl12,3 (3.62 ± 1.06 and 5.93 ± 1.81 h, respectively) and significant reductions in cefmetazole CLp (52.8 ± 14.3 and 30.2 ± 10.2 ml/min per 1.73 m2, respectively), compared with group 1. In seven subjects on chronic hemodialysis (group 4) studied during an interdialytic period, the cefmetazole tl/2, was increased to 24.10 ± 8.12 h and the CLp was reduced to 6.8 ± 2.1 ml/min per 1.73 M2. Cefmetazole CLp correlated positively with CLCR (r = 0.951, P < 0.001): CLp = (1.181 CLCR) -0.287. The disposition of cefmetazole was also assessed in six group 4 subjects during an intradialytic period.The t1/2, during hemodialysis (2.09 ± 0.69 h) was significantly shorter than that observed during the interdialytic period. The hemodialysis clearance of cefmetazole was 86.1 ± 20.1 ml/min, and the fraction of cefmetazole removed during hemodialysis was 59.8% ± 5.9%. It is recommended that patients with renal insufficiency receive standard doses of cefmetazole at extended intervals and patients on maintenance hemodialysis receive standard doses after hemodialysis.Cefmetazole sodium is an investigational parenteral cephamycin antibiotic possessing activity against a broad spectrum of both gram-positive and gram-negative aerobic and anaerobic bacteria (3, 6, 11, 13). The MIC for 90% of strains of clinically important pathogens, such as Staphylococcus aureus, Escherichia coli, Klebsiella spp., Proteus mirabilis, Haemophilus influenzae, and Neisseria spp., ranges between 0.012 and 4 ,ug/ml (6). Clinical studies in humans have demonstrated efficacy in the treatment of various infections (15), including pneumonia (L.