Cefotaxime concentrations in ascites

Moreau, L; Durand, H; Biclet, P

doi:10.1093/jac/6.suppl_a.121

Cited by 26 publications

(7 citation statements)

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“…Cefotaxime's half-life in cirrhotic patients was almost twice as long as that described in healthy human volunteers (Moreau et al, 1980). However, as this study was performed using a microbiological assay, care must be taken in interpreting the data.…”

Section: Cejotaximementioning

confidence: 89%

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Balant

Dayer

Auckenthaler

1985

Clinical Pharmacokinetics

106

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At the present time, the third generation cephalosporins that are already on the market or close to this point include cefsulodin, cefotaxime, cefoperazone, latamoxef, ceftriaxone, ceftazidime, ceftizoxime and cefotetan. Other newer compounds are also under development but have not been included in this review. None of the third generation compounds is suitable for oral administration and, accordingly, their pharmacokinetics have been studied only after intravenous and intramuscular administration. Microbiological assays and HPLC methods have been used for the measurement of plasma/serum, urine, bile and cerebrospinal fluid (CSF) concentrations. As found with cefotaxime, microbiological assays should only be used when the full metabolite spectrum of a particular drug is known, as otherwise, the presence of microbiologically active metabolites may lead to erroneous conclusions. Under normal conditions, the major route of elimination is via the kidneys for cefsulodin, latamoxef, ceftazidime, ceftizoxime and cefotetan. In contrast, cefoperazone is mainly eliminated in the bile, whereas cefotaxime and ceftriaxone depend both on the liver and the kidneys for their elimination. With the exception of ceftriaxone, which has a longer elimination half-life (i.e. around 8 hours), all the other third generation cephalosporins have a t1/2 ranging between 1.5 and 2.5 hours. Plasma protein binding is variable from one compound to another. However, the clinical relevance of this parameter is not clearly established since tissue penetration also depends on the relative affinity of the drug for tissue components. Third generation cephalosporins seem to penetrate adequately into the CSF and, thus pharmacokinetically appear to be appropriate agents for the treatment of meningitis. The degree of modification of pharmacokinetic parameters by renal insufficiency or hepatic diseases depends, as for other drugs, on the extent to which the compound is excreted via the kidneys or the liver. The third generation cephalosporins have been extensively studied under these conditions and recommendations for dosage modification in special circumstances are available for most of them. The pharmacokinetics of some third generation cephalosporins may be modified in neonates and elderly patients. Accordingly, their use at the extremes of age must be accompanied by a closer than usual clinical monitoring of the patient. From a clinical point of view, the third generation cephalosporins possess reliable pharmacokinetic properties.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Cejotaximementioning

confidence: 89%

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Balant

Dayer

Auckenthaler

1985

Clinical Pharmacokinetics

106

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“…CTX and d-CTX were found to interact synergistically against many microorganisms [17,19], allowing for possible dose reductions and for some CTX-resistant or moderately resistant organisms to be treated safely by high-dose CTX regimens [20]. CTX is mainly eliminated by the liver, and several authors have shown a prolonged serum half-life of CTX in cirrhotic patients [11,13,14]. The same phenomenon occurs in patients with reduced renal function in whom serum levels of CTX and d-CTX are much higher than in normal subjects, and the ratio of d-CTX to CTX increases significantly [9].…”

mentioning

confidence: 99%

Cefotaxime, Desacetyl‐Cefotaxime, and Bactericidal Activity in Spontaneous Bacterial Peritonitis

et al. 1999

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We have prospectively studied 13 episodes of spontaneous bacterial peritonitis (SBP) in 12 patients treated with cefotaxime (CTX) 2 g intravenously every 8 h (mean duration, 5.3 days). Ascitic fluid was inoculated at the bedside. The cultures were done before, during (day 3 after CTX initiation), and 48-72 h (mean, 56 h) after the end of therapy. All SBP episodes were monomicrobial. During treatment, the concentrations of CTX and desacetyl-cefotaxime (d-CTX) in ascitic fluid were high in all 13 SBP episodes, and d-CTX was still present in 6 patients who had residual ascitic bactericidal titer (ABT) activity after the last dose of CTX. ABTs were >/=1:128 during CTX therapy in 12 episodes and were measurable in 7 patients after the last dose. All patients were cured. The present study provides scientific rationale to the clinical studies that suggest treating SBP episodes with lower doses of antibiotics and shorter treatment duration.

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“…Studies of third-generation cephalospo rins have examined fluid obtained during peritoneal dialysis [2][3][4][5], surgery for peri tonitis [6] or evaluation of ascites [7][8][9], Data on the peritoneal fluid 'penetration' of antibiotics in the absence of inflamma tion or hepatorenal disease are extremely sparse; indeed, relevant literature is lim ited to analysis of postoperative peritoneal fluid drainage following administration of a 2-gram dose of moxalactam [10] or cef tazidime [1 1].…”

Section: Discussionmentioning

confidence: 99%

Penetration of Third-Generation Cephalosporins into Human Peritoneal Tissue

Berger¹,

Mercola²,

Serour³

et al. 1989

Chemotherapy

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Each of 40 patients underwent elective laparotomy following administration of a single 1.0-gram intravenous dose of ceftizoxime, ceftriaxone, cefoperazone or cefotaxime. Therapeutic concentrations of cefoperazone and ceftriaxone were achieved in peritoneal tissue in 20/20 patients. Only 9/20 samples from patients receiving the other two antibiotics had detectable antibiotic activity. The antibiotic concentration in peritoneal fluid (7 samples) was 2.36–11.15 times higher than that of concurrently obtained peritoneal tissue. When adjusted for the in vitro susceptibility (MIC) of potential peritoneal pathogens, our data suggest that ceftriaxone and cefoperazone may be preferable to other third-generation cephalosporins for the prophylaxis and therapy of intraabdominal infection.

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Cefotaxime concentrations in ascites

Cited by 26 publications

References 0 publications

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Cefotaxime, Desacetyl‐Cefotaxime, and Bactericidal Activity in Spontaneous Bacterial Peritonitis

Penetration of Third-Generation Cephalosporins into Human Peritoneal Tissue

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