No abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established technique and has considerable diagnostic value and therapeutic potential in patients with hepatobiliary disease. In experienced hands, ERCP is a safe procedure. The most important complications are pancreatitis, infection--ascending cholangitis and septicaemia--instrumental injury and haemorrhage. The reported incidence of bacteraemia complicating ERCP varies considerably (0.16-16%) but this may be due to differences in specimen collection and culture techniques. Clinically significant sepsis is the commonest cause of death due to ERCP with a case fatality rate of 8-20%. As the danger of sepsis was increasingly recognized, antibiotic prophylaxis was considered as routine policy in many centres; supporting evidence was retrospective. Significant differences between antibiotic and control groups are difficult to confirm in clinically controlled trials because of an insufficient number of patients and the low incidence of cholangitis and septicaemia. The optimum regimen is unknown and there is uncertainty regarding the duration of treatment required to provide adequate protection. Local variations in bacterial sensitivity should be taken into account when choosing the antimicrobial agent. In patients without clinical signs of biliary obstruction the risk of infection is low and prophylaxis may be unnecessary.

The day and night pharmacokinetics of assymetrical doses of slow release choline theophyllinate (Sabidal SR 270) were compared at day 1 and at day 4 of treatment when steady state had been achieved. Ten patients with chronic asthma were given oral choline theophyllinate 424 mg at 09.00 h and 848 mg at 21.00 h for 4 days. At regular intervals during day 1 and day 4 of treatment theophylline concentrations were measured in plasma and dried blood spots by fluorimmunoassay. Theophylline concentrations measured from dried blood spots were slightly lower than those in plasma, the difference remaining constant at all time points during day 1 and day 4 of treatment. On day 1 the mean peak plasma theophylline concentration was 5.4 +/‐ 1.0 (+/‐ s.e. mean) micrograms ml‐1 4 h after the morning dose and 11.2 +/‐ 1.6 micrograms ml‐1 4 h after the evening dose which were significantly (P less than 0.01) different. Similarly the areas under the plasma theophylline concentration‐time curves at night were significantly (P less than 0.001) greater than those observed during the day. During day 4 mean peak plasma concentrations of theophylline after the morning and larger evening dose were 13.2 +/‐ 1.3 and 12.1 +/‐ 1.4 micrograms ml‐1 respectively, which were not significantly different. No significant difference was observed between the areas under the plasma theophylline concentration‐time curves during the day and at night. However the post‐ dose time to peak was significantly delayed at night (6 h) compared to the morning (2 h, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)