cefotaxime and Cholangitis

To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed bile ducts and to determine simple predictive markers of effective biliary concentrations of these drugs.. Sixty-two patients treated with endoscopic biliary drainage were prospectively included in a nonrandomized way and received intravenous ciprofloxacin (200 mg twice daily) or cefotaxime (1 g three times a day) for more than 24 h before exploration. Blood and bile samples were collected at the time of drainage. Ciprofloxacin and cefotaxime concentrations were measured using high-performance liquid chromatography. Biliary penetration was assessed by the bile-to-plasma ratio of the concentrations of both antibiotics.. Biliary penetration ranged from 0.06 to 42.7 for ciprofloxacin and from 0.01 to 1.14 for cefotaxime. The ratio was more than one in only 10 patients (35%) and three patients (9%) in ciprofloxacin and cefotaxime groups, respectively. Biliary concentration of the drug was more than 10 times the minimal inhibitory concentration in only 10 patients (35%) and in 12 patients (35%) in ciprofloxacin and cefotaxime groups, respectively. Serum bilirubin, alkaline phosphatase or gamma-glutamyl-transpeptidase were not good predictive markers of the biliary diffusion of the antibiotics.. In patients with obstructed bile ducts, the biliary penetration of ciprofloxacin is poor and reaches effective biliary concentrations in a minority of patients. Cefotaxime biliary penetration is even poorer. No liver test can predict accurately the biliary penetration of the drugs.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bile; Bilirubin; Cefotaxime; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholestasis; Chromatography, High Pressure Liquid; Ciprofloxacin; Female; Humans; Male; Middle Aged; Prospective Studies

Biliary sepsis represents a major percentage of fatal complications after endoscopic retrograde cholangiopancreatography. We performed a randomized controlled study to investigate the value of antibiotic prophylaxis, and to assess the frequency and source of infectious complications associated with ERCP. Ninety-six patients who underwent 100 endoscopic retrograde cholangiopancreatographies were included in the study. Half of the patients received antibiotic prophylaxis (Cefotaxime 2 g i.v. 15 min before the procedure). Bacteremia was detected in 2% of the patients receiving antibiotic prophylaxis, as compared with 16% (p less than 0.02) in the control group. In order to determine the source of bacteremia, bile samples and irrigation fluid from the suction channel of the endo-scope were obtained for bacteriological evaluation. Several lines of evidence suggested that bacteremia associated with ERCP was essentially caused by mucosal lesions of the oropharynx. Bacteremia was asymptomatic, with the exception of two patients who subsequently developed fever, but recovered rapidly under antibiotic therapy. The frequency of cholangitis following ERCP was not significantly reduced by antibiotic prophylaxis (4% vs. 2%). Recommendations for antibiotic prophylaxis are discussed.

Topics: Cefotaxime; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Sepsis

Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.

Topics: Bile; Catheterization; Cefotaxime; Cholangiography; Cholangitis; Cholecystostomy; Combined Modality Therapy; Common Bile Duct Diseases; Cytomegalovirus Infections; Drainage; Fibrosis; Fluoroscopy; Ganciclovir; Hepatitis, Viral, Human; Hepatomegaly; Humans; Infant; Jaundice, Obstructive; Male; Radiography, Interventional; Ultrasonography; Ursodeoxycholic Acid

We describe what we believe to be the first case of biliary sepsis caused by Acinetobacter ursingii. The patient was a healthy woman with no comorbidities who presented with choledocholithiasis and cholangitis. The performance of an endoscopic cholangiopancreatography was the trigger for A. ursingii bacteraemia. This report highlights the inadequacies of conventional phenotypic tests usually available in clinical microbiology laboratories for the identification of Acinetobacter species.

Topics: Acinetobacter; Acinetobacter Infections; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Choledocholithiasis; Female; Humans; Middle Aged

The data on the taxonomic structure and antibiotic resistance of Enterobacteriaceae isolated from bile of patients with various clinical variants of cholangitis are presented. It was shown that bacteriocholia was registered in 53.3-90.9% of the patients during operations and in 88.9-100% of the patients during the postoperative period. Among bilicultures enterobacteria dominated (93.4% of the cases) with predominance of E. coli and Klebsiella spp. (the total about 70%). The enterobacteria isolates were frequently resistant to ampicillin and amoxycillin/clavulanate (92.6 and 70.4% of the strains respectively), gentamicin and amikacin (74.1 and 22.2%), cefazolin and cefotaxime (88.9 and 37.0%). The resistance to imipenem and ciprofloxacin (7.4%) was rare, that should be considered while prescribing drugs for empirical antimicrobial chemotherapy.

Topics: Adult; Aged; Aged, 80 and over; Amikacin; Amoxicillin; Anti-Bacterial Agents; Bile; Cefazolin; Cefotaxime; Cholangitis; Chronic Disease; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Gentamicins; Humans; Male; Middle Aged

Topics: Abscess; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Cefotaxime; Cephalosporins; Cholangitis; Female; Humans; Male; Middle Aged; Otitis Media; Pelvic Inflammatory Disease; Pharyngitis; Urinary Tract Infections