cefotaxime and Biliary-Tract-Diseases

Topics: Anti-Bacterial Agents; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cefotaxime; Ceftriaxone; Cephalosporins; Humans; Injections, Intravenous; Postoperative Complications; Premedication; Prospective Studies; Respiratory Tract Infections; Risk; Surgical Wound Infection

Topics: Biliary Tract Diseases; Cefotaxime; Dose-Response Relationship, Drug; Enterococcus faecalis; Escherichia coli; Humans; Injections, Intravenous; Prospective Studies; Pseudomonas; Random Allocation; Surgical Wound Infection

Topics: Biliary Tract Diseases; Cefotaxime; Dose-Response Relationship, Drug; Enterobacteriaceae; Female; Humans; Male; Middle Aged; Staphylococcus; Surgical Wound Infection

Topics: Bacteria; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Humans; Postoperative Complications; Stomach Diseases; Stomach Neoplasms; Surgical Wound Infection

A prospective, double-blind trial of a single preoperative dose of ceftriaxone, a new long-acting cephalosporin, versus one preoperative and three postoperative doses of cefazolin was carried out in 81 patients at high risk of infection after biliary surgery. Indications for antibiotic prophylaxis included recent or ongoing cholecystitis (52 patients), common duct stones (14 patients), common duct obstruction (3 patients), and age greater than 70 years (22 patients). Intraoperative bile cultures were positive in 7 of 41 patients (17.1 percent) given ceftriaxone and 12 of 40 patients (30 percent) given cefazolin, but there were no wound infections in either group. Neither regimen was associated with significant antibiotic resistance. Side effects, such as proteinuria and elevated liver transaminases and alkaline phosphatase levels, were transient and not definitely related to the antibiotics. We conclude that a single preoperative dose of ceftriaxone is as effective as multiple perioperative doses of cefazolin in the prophylaxis of infection associated with biliary tract surgery.

Topics: Adolescent; Adult; Aged; Bile; Biliary Tract Diseases; Cefazolin; Cefotaxime; Ceftriaxone; Cholecystectomy; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Humans; Infection Control; Male; Middle Aged; Postoperative Complications; Premedication; Random Allocation; Surgical Wound Infection

Topics: Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Clinical Trials as Topic; Endocarditis, Bacterial; Female; Genital Diseases, Female; Humans; Japan; Kinetics; Meningitis; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Cefixime is a new oral cephalosporin with in vitro activity similar to that of third-generation cephalosporins. Renal excretion accounts for only 40% of systemic clearance of cefixime, suggesting that biliary excretion of the drug may be significant. This study was designed to determine to what extent nonrenal clearance of cefixime is due to biliary excretion of the parent compound. In an isolated perfused rabbit liver model, biliary excretion of cefixime was very low, with only 0.28 +/- 0.15% of a single 10 mg dose injected in the system being recovered in the bile after three hours perfusion. The liver biotransformation rate for cefixime was found to be 16.2%. These results are in striking contrast with those obtained in human studies. Cefixime levels in duodenal juice aspirates collected over four hours following an intravenous injection of 200 mg cefixime in six healthy volunteers were at least fivefold concomitant serum levels. Studies of bile collected by external biliary drainage during 24 hours following an oral dose of 200 mg cefixime in ten cholecystectomized patients showed that the Cmax was 56.9 +/- 70 mg/l, i.e., 25-fold the serum Cmax (2.3 +/- 0.85 mg/l). The bile AUC/serum AUC ratio was 20.4 +/- 20.3. Mean bile level of cefixime was still as high as 4.3 +/- 3.7 mg/l 20 hours after dosing. The amount of cefixime excreted in the bile over 24 hours was 10.0 +/- 12.3 mg i.e., 5% of the dose administered. Twenty-four hour renal excretion of cefixime was 53.3 +/- 26.2 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Animals; Anti-Infective Agents, Urinary; Bacterial Infections; Bile; Biliary Tract Diseases; Cefixime; Cefotaxime; Cholecystectomy; Duodenum; Humans; In Vitro Techniques; Injections, Intravenous; Liver; Middle Aged; Postoperative Care; Rabbits; Reference Values

Clinical evaluation of cefmenoxime (CMX, Bestcall) was performed against infections associated with hematological, respiratory tract and other disorders. Clinical effectiveness of CMX against severe infections with hematological disorders including sepsis, pneumonia, pyelitis and so on was 74.4% for good responses and against the respiratory tract infections, 96.2% for good responses was obtained. Neither objective or subjective side effects nor extreme abnormalities in laboratory tests were observed in these patients. It can be concluded, therefore, that CMX is one of the most useful drugs against infectious diseases associated with hematological disorders, respiratory tract and other disorders.

Topics: Bacterial Infections; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Hematologic Diseases; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neutropenia; Pneumonia; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

To test the effectiveness of cefmenoxime (CMX) and cefotiam (CTM) in patients with biliary tract diseases, concentrations of either antibiotic were measured after an intravenous bolus injection of 1.0 g of CMX or CTM, or simultaneous injection of both (1.0 g each). CMX or CTM was injected in 76 patients with biliary tract diseases (mostly cholelithiasis) prior to a cholecystectomy and concentrations of CMX or CTM were measured by the bioassay (agar well) method at 30 to 60 minutes after the injection. Average concentrations of both CMX and CTM in gallbladder bile and gallbladder tissue sufficiently exceeded the minimal inhibitory concentration (MIC) against main causative organisms of biliary tract infections. Concentrations of both antibiotics in gallbladder bile were significantly higher in patients with patent cystic ducts than with obstructed cystic ducts. Concentrations of both antibiotics in the gallbladder tissue reached at a similar high level regardless of the patency of the cystic ducts, but concentrations were lower in severely inflamed gallbladders. CMX and CTM were administered alternatively (cross-over fashion), or simultaneously (combined) to 13 patients with T-tube drainage or percutaneous transhepatic cholangio-drainage, and concentrations of both antibiotics in bile from the drainage tube were measured by high performance liquid chromatography at hourly intervals after the injection. Concentrations of both antibiotics were far greater than MICs against main attributable microorganisms in biliary tract infections. The concentration of CMX slightly exceeded that of CTM. Concentrations of both antibiotics were lower in bile of patients showing abnormally high serum GTP, A1-P, and total bilirubin levels than in bile of patients with normal values of these variables. It is speculated that the secretion of both antibiotics in the bile may decrease in cases with severe hepatic failure, but effective concentrations of both antibiotics in the gallbladder tissue should be maintained as long as the blood circulation in the gallbladder was maintained.

Topics: Aged; Bile; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Cefotiam; Female; Gallbladder; Humans; Infant; Injections, Intravenous; Kinetics; Male; Middle Aged

Ceftizoxime (CZX) were administered and tested for the efficacy and safety in 80 elderly patients who were older than 65 years of age with infections. The sensitivity of bacteria found in these infections to CZX was examined before the administration of the drug. Serum concentrations and the rate of urinary output of the drug were examined in 3 cases. The clinical effect of CZX was as follows: 29 cases (36.3%) of excellent effectiveness and 31 cases (38.8%) showed moderate effectiveness. The patients were divided into 2 groups depending on the presence or the absence of other diseases in their backgrounds. Effectiveness of CZX for patients with and without other diseases were 74.0% and 85.7%, respectively. The effectiveness of CZX in patients with other diseases in their background was lower than the group without other diseases. Other antibiotics were used in 16 cases before the use of CZX. The effectiveness of CZX for these patients was 62.5%. Infecting bacteria were detected in a total of 46 cases (19 cases of respiratory infections and 27 cases of urinary tract infections). Among the respiratory cases, 8 were due to Gram-positive bacteria and 11 were due to Gram-negative bacteria. No Gram-positive organisms were detected from urinary tract infections, which were all due to Gram-negative bacteria. Sensitivities of isolates of these infecting bacteria to CZX were very sensitive 3 isolates, sensitive (++) 8 and slightly sensitive (+) 1 isolate. It was found that CZX was effective against 39 of 46 cases from which causative organisms were identified. The effectiveness ratio was 84.8%. Serum concentration of CZX was determined after a drip injection of 1 g CZX for 1 hour. The half-lives of CZX in plasma in healthy subjects and aged patients were 1.33 hours and 2.15 hours, respectively. The rate of urinary output of CZX during 6 hours after the injection was 76.4% in healthy subjects. Delayed urinary output which was 58.2% during 7 hours after injection was observed in aged patients. Fever in 1 patient and eosinophilia in 3 cases were observed after administration of CZX.

Topics: Age Factors; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftizoxime; Female; Humans; Kinetics; Male; Respiratory Tract Infections; Urinary Tract Infections

The penetration of cefmenoxime (CMX) into bile and gallbladder tissues was studied. A dose of 2 g CMX was given intravenously to each of patients with gallstones. Concentrations of CMX in the gallbladder tissues were 120.6 +/- 39.8 micrograms/g in normal tissues about 2 hours after the administration and 128.3 +/- 52.3 micrograms/g in inflamed tissues. The penetration of CMX into gallbladder tissue tended to decrease in proportion to the severity of inflammation, but the difference between the 2 groups, normal and inflamed tissues, were not statistically significant. The penetration of CMX into gallbladder tissue was presumed to increase in proportion to increase in the serum concentration of CMX. The result indicated that the achievement of high concentrations of CMX in the serum is important in the treatment of biliary tract diseases.

Topics: Adult; Aged; Bile; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Cholecystitis; Cholelithiasis; Female; Gallbladder; Humans; Male; Middle Aged

Basic and clinical studies in 37 patients with biliary tract disease on comparison between cefmenoxime (CMX) and cefotiam (CTM) were studied and the following results were obtained. In vitro antibacterial activities of CMX and CTM against 25 strains (15 organisms) isolated from bile of patients with biliary tract disease were stronger than that of cefazolin (CEZ). In cholecystectomized patients, CMX (2 g) or CTM (2 g) was injected intravenously, followed by determination of concentration in bile and gallbladder tissue about 2 hours after administration. In CMX administration, the mean concentration in gallbladder bile was 812.1 micrograms/ml, and the mean concentration in duct bile was 1,050.6 micrograms/ml, and the mean concentration in gallbladder tissue was 100.7 micrograms/g. In CTM administration, the mean values were, 1,092.5 micrograms/ml, 1,287.8 micrograms/ml, 28.5 micrograms/g, respectively. The concentration of CMX and CTM were almost similarly. The bile concentration of CMX (i.v.) was compared with CTM (i.v.) by cross-over method in cases of T-tube drainage. The peak bile concentrations of CMX and CTM were as high as 172.4 micrograms/ml and 182.2 micrograms/ml, respectively, 1 approximately 2 hours after 2 g intravenous administrations. Furthermore, the concentration of them were highly gained, 16.1 micrograms/ml of CMX and 33.8 micrograms/ml of CTM, even at 5 approximately 6 hours. In choledochostomized patients, CMX (4 g/day) was injected intravenously, followed by determination of concentration in intraperitoneal exudate. The mean concentration of CMX was 15.3 micrograms/ml on the first day after the operation, and 6.0 micrograms/ml even on the third day after the operation. Those results suggest that the high antibacterial activity of CMX against organism in bile and, the high penetration of CMX to bile, gallbladder tissue and intraperitoneal exudate will promise its important role in treatment of biliary tract infections.

Topics: Adult; Aged; Bacterial Infections; Bile; Biliary Tract Diseases; Cefmenoxime; Cefotaxime; Cefotiam; Cholecystectomy; Common Bile Duct; Female; Gallbladder; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Surgical Wound Infection

A clinical study was performed on concentration of cefotiam (CTM) in the gallbladder bile and the gallbladder tissue in benign diseases of the biliary tract. By an hour intravenous infusion the CTM concentration obtained 2 hours after the start of the infusion revealed that the level of the CTM in A bile was atmost same as that in B bile (3.1--46.0 micrograms/ml). The concentration in gallbladder tissue was 5.7--116 micrograms/ml. In addition, the CTM level was higher enough than the MIC of CTM covering more than 80% of the strains of E. coli and Klebsiella obtained from the focus. From these results, it is concluded that CTM is clinically effective and useful in the case of biliary disease.

Topics: Aged; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Female; Gallbladder; Humans; Male; Middle Aged

Twelve infants having undergone extrahepatic cholangiojejunostomy (SURUGA'S procedure II) after portal hepaticojejunostomy as a radical operation for congenital biliary atresia received prophylactic cefotiam (CTM) against biliary tract infection, 50 mg/kg by intravenous drip in 1 hour, followed by serial determinations of bile and serum CTM levels. The patients were evaluated as to degree of CTM excretion into the bile, by classification into 4 groups according to success or failure in establishing the anastomosis, bile outflow and persistence of jaundice. Patients with an established anastomosis, satisfactory bile flow and no longer jaundice showed high biliary antibiotic concentrations whereas lower biliary antibiotic levels were seen in those with failure in anastomosis, poor bile flow and persistent jaundice. In both cases, nevertheless, the antibiotic concentration in bile sufficiently exceeded the MIC80 values of CTM against principal bacterial pathogens causative of biliary tract infections, thus demonstrating clinical significance of the use of CTM for this purpose. The antibiotic excretion into the bile improved with normalization of liver function in an infant displaying satisfactory bile outflow from an early postoperative stage. The bile and serum CTM assay data obtained by the agar well method showed a high degree of correlation with those by high performance liquid chromatography.

Topics: Bacterial Infections; Bile; Bile Ducts; Biliary Tract Diseases; Cefotaxime; Cefotiam; Female; Humans; Infant, Newborn; Infusions, Parenteral; Male; Postoperative Complications; Premedication

In 12 patients undergoing operation, 1 g of cefotiam (CTM) was administered intravenously and CTM levels in gallbladder tissue and gallbladder bile were examined. CTM concentration in gallbladder bile was high in patients with patent cystic duct, while very low in those with cystic duct obstruction. CTM concentration in gallbladder tissue was low in patients with chronic inflammatory gallbladder. CTM activities of T-tube bile were compared with those of CMZ by cross over method in 2 cases. CTM showed extremely higher concentration in bile than CMZ. In a case with excessive output of bile, CTM activity, total bile acids concentration and canalicular flow/ductal flow ratio were low. It can be presumed that CTM was diluted by increased ductal secretion.

Topics: Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Female; Gallbladder; Humans; Middle Aged

Topics: Adult; Aged; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Female; Gallbladder; Humans; Liver; Liver Function Tests; Male; Middle Aged; Time Factors

Eighteen patients with 21 serious infections were treated with ceftriaxone, 1 g intravenously every 12 h, for a mean duration of 8 days. Eighteen gram-negative and two gram-positive organisms were isolated. Sites of infection included blood (three patients), urinary tract (six patients), respiratory tract (seven patients), biliary tract (three patients), ascitic fluid (one patient), and skin (one patient). Serum, bile, and ascitic fluid concentrations of ceftriaxone were in excess of the minimal bactericidal concentration required for the infecting organism in all cases. A bacteriological response was demonstrated in 94% of the infections. A clinical response occurred in four infections from which no pathogens were recovered. In one patient, ceftriaxone failed to eradicate a peritoneal infection due to Bacteroides fragilis. In two patients, superinfection with enterococci developed both during and after therapy. Systemic tolerance to ceftriaxone was excellent.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Humans; Male; Middle Aged; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Laboratory and clinical comparative investigations with cefotiam (CTM) and cefazolin (CEZ) were performed to confirm efficacy and safety in surgical, biliary tract infections. The following results were obtained. 1) The MICs of CTM against organisms, 20 strains, which were isolated from bile of patients with cholecystitis, were studied, especially those of CTM against E. coli and Klebsiella were 0.2 - greater than or equal to 100 micrograms/ml and 0.1--12.5 micrograms/ml, respectively, considerably lower than those of CEZ. And moreover against CEZ-resistant Proteus morganii and Serratia marcescens, CTM showed potent activities, that is, MIC values, 12.5--50 micrograms/ml and 0.78 microgram/ml, respectively. 2) In cholecystectomized patients, 2 grams of CTM was injected intravenously, followed by determination of bile concentration in gallbladder, common bile duct and concentration of gallbladder and liver tissue about 2 hours after administration. The mean bile concentrations of CTM in gallbladder and common bile duct were 1,213.2 micrograms/ml and 1,287.8 micrograms/ml, respectively. The peak concentration of CTM was 2,919.0 micrograms/ml. The mean concentrations of CTM in gallbladder and liver tissue were 28.5 micrograms/g and 45.7 micrograms/g, respectively. On the other hand, the mean bile concentrations of CEZ in gallbladder and common bile duct were 138.7 micrograms/ml and 128.8 micrograms/ml, respectively. 3) Bile concentrations of CTM was compared with those of CEZ by crossover method. The concentration of CTM was 37.7 micrograms/ml even at 5 or 6 hours after 2 grams intravenously administration. CTM showed extremely higher concentration than CEZ in bile. 4) The clinical effect was studied in 6 cases of surgical, biliary tract infections. The results were excellent in 2 cases, good in 3 cases and poor in 1 case, and the clinical efficacy was 83%. 5) CTM was administered to 6 patients who showed negative to intracutaneous reaction test. Nausea, itching, and eruption were observed in each 1 case after intravenously administration of CTM 2 g, however these adverse reactions disappeared within several hours. Throughout the course of treatment, any unusual laboratory findings related to CTM were not observed.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Cholecystectomy; Drug Evaluation; Drug Resistance, Microbial; Female; Gallbladder; Humans; Liver; Male; Middle Aged

As useful antibiotics for biliary tract infections, smooth transmigration to lesion and potent antibacterial activities will be demanded. Usually the antibiotics having potent antibacterial activities against E. coli and Klebsiella, which are considered to be main causative organisms of biliary tract infections, will be used for treatment. The concentrations of cefotiam (CTM) in bile and gallbladder wall tissue were investigated, and CTM showed very high concentrations in these tissues for several hours. And very good correlation between concentration of CTM in bile and laboratory findings, especially ICG R15 value, was obtained. CTM showed also very potent antibacterial activities against E. coli and Klebsiella. These results suggest that CTM will be useful agent for the treatment of biliary tract infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Bile; Biliary Tract Diseases; Cefotaxime; Cefotiam; Drug Resistance, Microbial; Female; Gallbladder; Humans; Male; Middle Aged