cefepime and Cholecystitis

Topics: Abdomen; Bacterial Infections; Cefepime; Cephalosporins; Cholecystitis; Gastrointestinal Diseases; Peritonitis; Surgical Wound Infection

In patients with acute cholecystitis, antibiotics are used as an adjunct to cholecystectomy to reduce the incidence of postoperative septic complications thought to be related to bactibilia. Combinations of penicillins, or cephalosporins or aminoglycosides, or both, are often used. Cefepime is a fourth-generation cephalosporin with excellent activity against gram-positive and gram-negative bacteria, including Pseudomonas species. It has a prolonged serum half-life, allowing twice-daily dosing, and is not nephrotoxic. This study was undertaken to determine whether or not cefepime was as effective as the combination of gentamicin and mezlocillin in patients with acute cholecystitis. One hundred and forty-nine patients were randomized, two to one, to receive cefepime or gentamicin and mezlocillin. Cefepime was given intravenously at 2 grams every 12 hours; gentamicin, 1.0 to 1.5 milligrams per kilograms every eight hours, and mezlocillin, 3 to 4 grams every four to six hours. All patients underwent cholecystectomy. Bile cultures were obtained, and concentrations of cefepime in blood, bile, peritoneal fluid and gallbladder were determined in a subset of patients. There were 56 evaluable cefepime-treated and 34 evaluable gentamicin and mezlocillin-treated patients. Bactibilia was present in 17 of 56 cefepime-treated patients (30.4 percent) and ten of 34 gentamicin and mezlocillin-treated patients (29.4 percent). Enterococci were recovered in six cefepime-treated patients. Clinical and bacteriologic responses were similar for the cefepime-treated and gentamicin and mezlocillin-treated groups, with one failure in each group, a wound infection in a patient receiving cefepime and a subhepatic abscess in a patients receiving gentamicin and mezlocillin. Other measures of outcome, such as the number of days of fever, days nothing by mouth, days of hospitalization and days of antibiotic therapy were similar in both groups. Cefepime, with every 12 hour dosing, achieved extremely high concentrations in all tissues assayed at the time of the operation, a mean of eight hours after administration. Adverse clinical events were similar in both treatment groups. Cefepime is as effective as gentamicin and mezlocillin in preventing septic complications after cholecystectomy for acute cholecystitis. Cefepime requires fewer doses, does not require drug monitoring, is not associated with nephrotoxicity and may therefore prove to be a cost-effective alternative to combination thera

Topics: Acute Disease; Adult; Aged; Cefepime; Cephalosporins; Chemotherapy, Adjuvant; Cholecystitis; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Mezlocillin; Middle Aged; Treatment Outcome

Topics: Acute Disease; Adult; Cefepime; Cephalosporins; Cholecystectomy; Cholecystitis; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Surgical Wound Infection

Cefepime is a new broad-spectrum cephalosporin with activity against Staphylococcus, Streptococcus, Pseudomonas, and the Enterobacteriaceae. The purpose of this study was to measure cefepime concentrations in plasma, peritoneal fluid, bile fluid and appendix tissue in patients undergoing elective cholecystectomy. Patients were randomly assigned to receive either cefepime, 2 g intravenously in phosphate buffer (IVPB) q 12 h or gentamicin 1.5 mg/kg IVPB q 8 h plus mezlocillin 4 g IVPB q 6 h. During surgery, gall bladder tissue, plasma, peritoneal fluid, and bile fluid samples were obtained at approximately the same time. Thirty-three patients had data acceptable for analysis. Values are given as mean +/- standard deviation. The mean delta time (defined as the time between the administration of cefepime and the time the samples were obtained) was 8.58 +/- 3.53 h. The values for plasma, peritoneal fluid, bile fluid, and gall bladder tissue concentrations were 7.63 +/- 14.17 micrograms/ml, 5.66 +/- 6.80 micrograms/ml, 15.51 +/- 16.94 micrograms/ml, and 5.36 +/- 6.57 micrograms/gm, respectively. The peritoneal fluid/plasma ratio was 2.10 +/- 2.33, the bile fluid/plasma ratio was 14.44 +/- 31.99, and the gall bladder tissue/plasma ratio was 1.44 +/- 1.82. There was a significant correlation between peritoneal fluid and plasma concentration (r = 0.91, p less than 0.0005), and gall bladder tissue and plasma concentration (r = 0.90, p less than 0.0005). There was no correlation between bile fluid and plasma cefepime concentrations. The minimum inhibitory concentration (MIC) data from previous in vitro studies indicate that cefepime concentrations achieved in this patient population would be adequate against typical biliary tract pathogens.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Adult; Ascitic Fluid; Bile; Cefepime; Cephalosporins; Cholecystectomy; Cholecystitis; Female; Gallbladder; Humans; Injections, Intravenous; Male; Middle Aged; Premedication; Regression Analysis

The purpose of this study was to determine the cefepime concentrations in serum, bile and gall bladder tissue after administration of a single dose in patients with extrahepatic biliary diseases for pre-operative antimicrobial prophylaxis. During a 3-year period (1999-2002), 30 patients aged above 18 years with extrahepatic biliary diseases (acute and chronic cholecystitis and symptomatic cholelithiasis) were included in the study. Cefepime concentrations were determined by the agar microbiological diffusion method. A significant correlation between serum and gall bladder tissue concentrations of cefepime with the sampling interval was observed (r2 = 0.771, P<0.0001), whereas no correlation between serum and bile fluid concentrations of the drug was noted. In patients with non-functioning gall bladder, very low tissue levels of cefepime were detected. During the time of surgery, serum and gall bladder tissue concentrations of cefepime exceeded the minimum inhibitory concentration for 90% of the organisms (MIC90) for most common pathogens. Cefepime has the required pharmacokinetic properties to be considered for pre-operative antimicrobial prophylaxis in patients undergoing biliary tract surgery.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Area Under Curve; Bile; Cefepime; Cephalosporins; Cholecystectomy; Cholecystitis; Cholecystolithiasis; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Polyps

Topics: Acute Disease; Aged; Bacteremia; Cefepime; Cephalosporins; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystitis; Enterobacteriaceae Infections; Gentamicins; Hafnia alvei; Humans; Liver Abscess; Male; Netilmicin; Suppuration; Treatment Outcome