Summary
The biliary elimination of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) were measured by HPLC in nine recently cholecystectomised patients following the i. v. injection of 15 mg/kg body weight of CTX. All of the bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube. Biliary clearance of CTX and DSCTX was measured for 8 h. Cefotaxime peaked at 90 min after injection at 34.5 ± 15.3 mg/l; in the 7–8 h sample it was 2.7 ± 1.7 mg/l. DSCTX peaked at the same time at 49.3 ± 17.0 mg/l, and was 4.6 ± 3.2 mg/l at 8 h. The bile/serum ratio of CTX and DSCTX concentrations was above 1 from the first to the eighth hours (range: 1.35 ± 1.08 to 11.0 ± 3.1). The biliary clearance of CTX was 0.190 ml/min. The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 ± 472.8 µg and 1902.7 ± 804.1 µg (0.093 ± 0.041% of the dose and 0.186 ± 0.077% of the dose). Considering the minimum inhibitory concentration of the pathogens currently encountered in biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.
Zusammenfassung
Die Gallenausscheidung von Cefotaxime (CTX) und dessen Metaboliten Desacetylcefotaxime (DSCTX) werden bei 9 kürzlich cholezystektomierten Patientinnen nach einer intravenösen Injektion von 15 mg/kg Körpergewicht CTX gemessen. Die gesamte Galle wurde durch ein spezielles Vorgehen gesammelt: der aufgeblasene Ballon eines Fogarty Katheters wurde in den distalen Zweig eines Kehr-T-Drains eingeführt. Die biliäre Clearance des CTX und des DSCTX wurde während 8 Stunden gemessen. Die CTX-Konzentration erreichte Spitzenwerte von 34,5 ± 15,3 mg/l 90 Minuten nach der Injektion. Diese Werte sanken auf 2,7 ± 1,7 mg/l nach 7–8 Stunden. DSCTX erreichte seine Spitzenkonzentration zur gleichen Zeit mit 49,3 ± 1,7 mg/l und fiel auf 4,6 ± 3,2 mg/l nach 8 Stunden. Das Konzentrationsverhältnis Galle/Serum von CTX und DSCTX blieb bei 1 während der ganzen Probezeit (Mittelwerte 1,35 ± 1,08 bis 11,0 ± 3,1). Die biliäre Clearance von CTX war 0,190 ml/min. Die Gesamtmenge an in der Galle ausgeschiedenem CTX und DSCTX betrug 1050 ± 472,8 µg bzw. 1902,7 ± 804,1 µg (0,093 ± 0,041% bzw. 0,186 ± 0,077% der Dosis). Wenn man die minimalen Hemmkonzentrationen der häufigsten Erreger bei biliärer Sepsis betrachtet, scheint CTX ein geeignetes Antibiotikum für die Behandlung von biliären Infektionen zu sein.
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Jehl, F., Peter, J.D., Dupeyron, J.P. et al. Investigation of the biliary clearances of cefotaxime and desacetylcefotaxime by an original procedure in cholecystectomised patients. Infection 15, 450–454 (1987). https://doi.org/10.1007/BF01647231
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DOI: https://doi.org/10.1007/BF01647231