Ascitic fluid and serum cefotaxime and desacetyl cefotaxime levels in patients treated for bacterial peritonitis


Forty-one episodes of ascitic fluid infection were treated with cefotaxime 2 g intravenously every 8 hr, and ascitic fluid and serum were sampled 6, 12, 24, 48, and 96 hr after the first dose of antibiotic. Concentrations of cefotaxime and desacetyl cefotaxime were measured in ascitic fluid and serum by high-performance liquid chromatography. There was essentially 100% penetration of cefotaxime and metabolite from serum into ascitic fluid at all time points. Ascitic fluid was sterilized in 94% of episodes after the first dose of antibiotic. The ascitic fluid concentration of cefotaxime 6 hr after the first dose of antibiotic was greater than 20 times the minimal inhibitory concentration of the drug for 90% of the isolated flora. This rapid ascitic fluid penetration of cefotaxime in high concentration explains the rapid sterilization of ascitic fluid by the drug in the setting of bacterial peritonitis and obviates the need to give a loading dose or intraperitoneal injection.

This is a preview of subscription content, log in to check access.


  1. 1.

    Gerding DN, Hall WH, Schierl EA: Antibiotic concentration in ascitic fluid of patients with ascites and bacterial peritonitis. Ann Intern Med 86:708–713, 1977

    Google Scholar 

  2. 2.

    Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Gines P, Rodes J: Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections. Hepatology 5:457–462, 1985

    Google Scholar 

  3. 3.

    Moreau L, Durand H, Biclet P: Cefotaxime concentration in ascites. J Antimicrob Chemother 6A:121–122, 1980

    Google Scholar 

  4. 4.

    Galy J, Mantel O: Concentrations de cefotaxime dans les tissues et liquides de l'organisme. Nouv Presse Med 26:565–573, 1981

    Google Scholar 

  5. 5.

    Koda RT, Ko RJ, Nichols S, Akriviadis E, Cohen JL, Runyon B, Sattler FR: Factors influencing the disposition of cefotaxime in various stages of liver disease. Clin Pharmacol Ther 47:154, 1990 (abstract)

    Google Scholar 

  6. 6.

    Lassman HB, Coombes JD: Metabolism of cefotaxime: A review. Diagn Microbiol Infect Dis 2:3S-12S, 1984

    Google Scholar 

  7. 7.

    Runyon BA, Canawati HN, Akriviadis EA: Optimization of ascitic fluid culture technique. Gastroenterology 5:1351–1353, 1988

    Google Scholar 

  8. 8.

    Fabre H, Kok WT: Determination of cephalosporins and decomposition products by liquid chromatography with indirect electrochemical detection. Anal Chem 60:136–141, 1988

    Google Scholar 

  9. 9.

    Runyon BA, Hoefs JC: Culture-negative neutrocytic ascites: A variant of spontaneous bacterial peritonitis. Hepatology 4:1209–1211, 1984

    Google Scholar 

  10. 10.

    Akriviadis EA, Runyon BA: The value of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 98:127–133, 1990

    Google Scholar 

  11. 11.

    Weinstein MP, Iannini PB, Stratton VW, Eickoff TC: Spontaneous bacterial peritonitis: A review of 28 cases with emphasis on survival and factors influencing prognosis. Am J Med 64:592–598, 1978

    Google Scholar 

  12. 12.

    Runyon BA: Spontaneous bacterial peritonitis: An explosion of information. Hepatology 8:171–175, 1988

    Google Scholar 

  13. 13.

    Gill MA, Kern JW: Altered gentamicin distribution in ascitic patients. Am J Hosp Pharm 36:1704–1706, 1979

    Google Scholar 

  14. 14.

    Papadakis MA, Arieff AI: Unpredictability of clinical evaluation of renal function in cirrhosis. Am J Med 82:945–952, 1987

    Google Scholar 

  15. 15.

    Cabrera J, Aroyo V, Ballesta AM, Rimola A, Gual J, Elena M, Rodes J: Aminoglycoside nephrotoxicity in cirrhosis: Value of urinary b2-microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 82:97–105, 1982

    Google Scholar 

  16. 16.

    Moore RD, Smith CR, Lietman PS: Increased risk of renal disfunction due to interaction of liver disease and aminoglycoside. Am J Med 80:1093–1097, 1986

    Google Scholar 

Download references

Author information



Corresponding authors

Correspondence to Dr. B. A. Runyon MD or Dr. J. Cohen PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Runyon, B.A., Akriviadis, E.A., Sattler, F.R. et al. Ascitic fluid and serum cefotaxime and desacetyl cefotaxime levels in patients treated for bacterial peritonitis. Digest Dis Sci 36, 1782–1786 (1991).

Download citation

Key Words

  • spontaneous bacterial peritonitis
  • cefotaxime
  • ascitic fluid
  • antibiotic concentration