ro13-9904 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

In this randomized, single-blind, case-controlled, prospective study, the incidence and outcome of ceftriaxone-associated biliary pseudolithiasis in Chinese children was evaluated via ultrasonography. A total of 108 children diagnosed with hepatobiliary infection or pneumonia were randomized to receive ceftriaxone or ceftazidime. Serial gallbladder sonograms were obtained on days 1, 5 - 7 and 10 - 14 of therapy. Gallstones were detected in 43.10% of patients in the ceftriaxone-treated group and in 2.00% of the ceftazidime-treated group. The incidence of pseudolithiasis was significantly higher in the ceftriaxone-treated than the ceftazidime-treated group. Biliary precipitation abnormalities appeared after 2 - 7 days of treatment. After gallstones were found, the drug was stopped and symptoms resolved within 1 - 2 days. This study suggests that the risk of ceftriaxone-associated biliary pseudolithiasis should be considered when treating Chinese children.

Topics: Adolescent; Anti-Bacterial Agents; Asian People; Biliary Tract Diseases; Ceftazidime; Ceftriaxone; Child; Child, Preschool; China; Female; Gallbladder; Humans; Infant; Male; Pneumonia; Ultrasonography

The gallbladder wall, gallbladder lumen and bile duct intraoperative sampling materials had been examined in 52 patients with an operation on the biliary tract. All patients were treated by only one infusion before operation: 1 g ceftriaxone was given to 26 patients and 2 g ceftriaxone to the 26 others. Bacterial species were isolated on twenty patients. There was no significant difference in infection rate and organism identity between bacterial flora isolated from patients receiving 1 g ceftriaxone and patients receiving 2 g. Isolated germs were enterobacteriaceae (15) streptococci (14) and anaerobic bacteria (8). The mean count of bacteria in bile is 10(4) germs/ml. Half positive sampling materials contains more than one bacterial strain. The bacterial flora isolated from bile has characteristics of mixed flora infection. Ceftriaxone had a good efficacy in antibiotic prophylaxis.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Bile; Bile Ducts; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Ceftriaxone; Gallbladder; Humans; Middle Aged

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

Ceftriaxone (CTRX) is a known cause of biliary pseudolithiasis (BPL) mainly in children. Biliary elimination of CTRX increases in patients with renal dysfunction. However, the influence of renal dysfunction on the incidence of CTRX-associated BPL has not been well investigated. The aim of this study was to investigate the cumulative incidence of CTRX-associated BPL in adults and to assess if renal dysfunction is a risk factor.. We retrospectively analyzed the medical records of 478 patients treated with CTRX to assess the incidence and risk factors of CTRX-associated BPL. We examined age, sex, body weight, dosage, and duration of CTRX therapy, and the concentrations of serum creatinine, estimated glomerular filtration rate (eGFR), albumin, and serum calcium in all the patients. The cumulative incidence of BPL was calculated using a competing risk model. The multivariate analysis of each variable for the development of BPL was assessed by a Cox proportional hazards model.. A total of 362 patients (75.7%) had renal dysfunction (eGFR: < 60 mL/min). The cumulative incidence of BPL in patients with renal dysfunction was significantly higher than that in patients with normal kidney function (4.1 vs. 0.6%, p = 0.017). Renal dysfunction (Hazard ratio (HR) 8.14, 95% CI 1.05-63.0, p = 0.045) and female sex (HR 5.35, 95% CI 1.17-24.5, p = 0.031) were independent risk factors of CTRX-associated BPL, which was confirmed using multivariate analysis (renal dysfunction: HR 7.93, 95% CI 1.04-60.5, p = 0.046) (female sex HR 4.65, 95% CI 1.03-21.1, p = 0.046).. Renal dysfunction is an independent risk factor of CTRX-associated BPL in adults.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Biliary Tract Diseases; Ceftriaxone; Female; Humans; Incidence; Japan; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Risk Factors

Topics: Anti-Bacterial Agents; Biliary Tract Diseases; Ceftriaxone; Child; Cholelithiasis; Colic; Female; Humans; Time Factors; Ultrasonography

This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series, with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.

Topics: Aged; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Biliary Tract Diseases; Candidiasis; Ceftriaxone; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Female; Fluconazole; Humans; Male; Middle Aged; Staphylococcal Infections

In order to evaluate antimicrobial activity of ceftriaxone (CTRX), minimum inhibitory concentrations (MICs) of CTRX and control drugs were determined against clinically isolated strains including those from purulent meningitis and liver and biliary tract infections in 1995. The results are summarized as follows; 1. MIC90 of CTRX was 0.05 micrograms/ml against benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae or PCG-resistant S. pneumoniae and it was < or = 0.025 micrograms/ml against beta-lactamase producing strains of Haemophilus influenzae. Antimicrobial activities of CTRX against these strains were stronger than control drugs. 2. MIC distribution of CTRX was in a lower concentration range than those of ceftazidime and flomoxef against extend broad-spectrum beta-lactamase (EBLA)-producing Escherichia coli and Klebsiella pneumoniae subsp. pneumoniae. 3. These results suggested that CTRX will be effective against community-acquired pneumonia, purulent meningitis and liver & biliary tract infections.

Topics: Biliary Tract Diseases; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Escherichia coli; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Meningitis; Penicillin G; Pneumonia; Streptococcus pneumoniae

Lyme disease (LD) is endemic in Monmouth and Ocean counties, New Jersey (1). In June 1992, CDC and the New Jersey Department of Health (NJDOH) conducted a telephone survey in both counties of 65 schoolchildren who required home instruction because of suspected LD to determine the public health impact of the disease. Most children had received prolonged and repeated courses of oral antimicrobials and/or home intravenous infusion of antimicrobials; 79% had been hospitalized for treatment of suspected LD or management of treatment complications, most notably drug-induced symptoms of gallbladder disease occurring in patients receiving ceftriaxone (Rocephin), and bloodstream infections associated with intravenous catheters. To determine the characteristics of and treatment complications for patients hospitalized for treatment of LD, a computerized search of hospital discharge data in New Jersey was performed; nearly 30% of all hospitalizations for LD during 1990-1991 were at a regional hospital serving Monmouth and Ocean counties. This report presents findings of an analysis of patients admitted to that hospital for treatment of LD.

Topics: Adolescent; Adult; Biliary Tract Diseases; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Female; Humans; Infusions, Intravenous; Lyme Disease; Male; New Jersey; Risk Factors

Topics: Adolescent; Adult; Biliary Tract Diseases; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Female; Humans; Infusions, Intravenous; Lyme Disease; Male; New Jersey; Risk Factors

Ceftriaxone, a semisynthetic third-generation cephalosporin, has recently been associated with biliary sludge formation. Analysis of the biliary concretions induced by this agent shows a calcium salt of ceftriaxone. The present in vitro studies were undertaken to provide insight into the pathogenesis of ceftriaxone-associated biliary sludge formation by evaluating possible interactions that may exist between calcium, bile salts, and ceftriaxone. Ceftriaxone possessed high calcium-binding affinity. The formation constant for the calcium ceftriaxone salt at 37 degrees C was about 157.3 L/mol; stoichiometry of the salt was 1:1, i.e., calcium ceftriaxone. The calcium-binding property of ceftriaxone was observed to be additive to that of taurocholate in mixed taurocholate-ceftriaxone solutions. Although the solubility product constant for calcium ceftriaxone was only 1.62 x 10(-6) mol/L2, marked metastability was observed; neither visible nor microscopic precipitates developed until the [Ca2+] x [ceftriaxone] ion product exceeded the solubility product constant by a factor of 10.4. Metastability of the calcium ceftriaxone salt was also observed in human gallbladder bile in vitro. Estimates of human biliary calcium ceftriaxone solubility in vivo were than calculated from previously-reported values for biliary [Ca2+], [ceftriaxone], and from the solubility product constant as defined in this study. Calculated saturation indices for calcium-ceftriaxone in human bile generally increased (corresponding to a decrease in solubility) with increasing ceftriaxone dose. At doses less than or equal to 1 g, saturation index was well within the metastable range of this calcium-salt. However, at doses greater than or equal to 2 g, the saturation index surpassed the metastable limit. Under these conditions, precipitation of ceftriaxone could occur. It was concluded that the development of ceftriaxone-induced biliary sludge is a solubility problem that occurs in patients receiving high-dose treatment (greater than or equal to 2 g). This study proposes that the risk of developing ceftriaxone-associated biliary "pseudolithiasis" increases with increasing ceftriaxone dose and in patients with impaired gallbladder emptying.

Topics: Bile; Biliary Tract Diseases; Calcium; Ceftriaxone; Chemical Phenomena; Chemistry, Physical; Humans; Osmolar Concentration; Solubility; Taurocholic Acid

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