Penetration of Third-Generation Cephalosporins into Human Peritoneal Tissue

Berger, Stephen A.; Mercola, Dan; Serour, Francis; Gorea, Alfred; Levenberg, A; Krispin, M

doi:10.1159/000238689

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Since a variety of antimicrobial regimens were used in these patients, it is very difficult to draw any conclusions regarding single-agent therapy. However, most of the antibiotics administered to these patients were shown to achieve concentrations in synovial fluid, peritoneal fluid, or bone in excess of their MICs for penicillin-resistant isolates (21,26,72,98,104,123). In synovial fluid, ceftriaxone reaches a level of up to 66 to 100% of the concomitant levels in serum.…”

Section: Miscellaneous Infectionsmentioning

confidence: 99%

Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae

1998

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SUMMARY Antibiotic-resistant strains of Streptococcus pneumoniae are becoming more prevalent throughout the world; this has resulted in modifications of treatment approaches. Management of bacterial meningitis has the greatest consensus. Strategies for treating other systemic infections such as pneumonia, bacteremia, and musculoskeletal infections are evolving, in part related to the availability of new antibiotics which are active in vitro against isolates resistant to penicillin and the extended-spectrum cephalosporins. However, there are currently very limited data related to the clinical efficacy of these new agents. The studies upon which current recommendations are based are reviewed. Otitis media represents the single most common infection due to S. pneumoniae. Recommendations for treatment of acute otitis media due to drug-resistant strains and the rationale for these recommendations are discussed.

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Section: Miscellaneous Infectionsmentioning

confidence: 99%

Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae

1998

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“…These drugs were chosen because of their known pharmacokinetic properties and their spectra of activity (3,12,16). Plasma and epiploic fat drug concentrations were determined until the end of the surgical procedure.…”

Section: Resultsmentioning

confidence: 99%

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Steib

Jacoberger

Bandel

et al. 1993

Antimicrob Agents Chemother

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Plasma and epiploic fat drug concentrations and fat penetration of ceftriaxone and ornidazole given for antimicrobial prophylaxis were studied in 11 patients scheduled for liver transplantation. Ceftriaxone (1 g) and ornidazole (500 mg) were infused during 30 min after the induction of anesthesia. Arterial blood and epiploic fat samples were collected at 30, 60, and 120 min and then every 90 min following the end of the infusion until closure of the peritoneum. Blood samples were immediately centrifuged, and plasma and fat were stored at -35°C until analysis. Ceftriaxone and ornidazole concentrations were determined by high-performance liquid chromatography. Surgery lasted 440 + 84 min and required a mean of 9.5 units of packed erythrocytes and 13 units of fresh frozen plasma. Plasma ceftriaxone concentrations decreased from 89 ± 34 to 41 ± 16.5 ,ag/ml from the beginning of the operation until the time of closure of the peritoneum. Corresponding levels in epiploic fat decreased from 8.7 + 3.3 to 4.5 + 3.5 ag/g. Ornidazole concentrations ranged, respectively, between 8.7 + 2.5 and 4.9 ± 1.7 ,ug/ml in plasma samples and 4.6 ± 1.2 and 2.5 _ 1.1. ,g/g in fat samples. Rates of penetration into the omentum remained at about 9%o for ceftriaxone and between 50 and 70%o for ornidazole. Tissue ceftriaxone concentrations were, in all cases, greater than typical MICs for 90%o for Escherichia coli and KlebsieUla isolates tested (MIC90s). They were insufficient in 40o of patients after 60 min with regard to the MIC90s for Staphylococcus aureus. Tissue ornidazole concentrations were not superior to MIC,0s for anaerobes after 30 min in 50%o of patients. These results show that a single dose of 1 g of ceftriaxone provides adequate coverage against gram-negative bacteria and that 1 g instead of 500 mg of ornidazole may provide a protective effect against anaerobes during liver transplantation. Prophylaxis against S. aureus and Streptococcusfaecalis requires more specific antibiotics. Prophylaxis for patients with significant blood loss or initial severe renal or hepatic failure needs further evaluation.

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“…Although some studies suggest that treatment with ceftriaxone results in higher concentrations than ceftriaxone in peritoneal fluid and has pharmacokinetic characteristics superior to those of cefotaxime, the concentrations of both agents in tissue and peritoneal fluid are greater than the minimum level necessary to inhibit the growth of peritoneal pathogens (5,12). In theory, the only disadvantage of using these cephalosporins in the treatment of peritoneal infection is their low activity against E. faecalis and Bacteroidesfragilis.…”

Section: Discussionmentioning

confidence: 99%

“…Broad-spectrum cephalosporins which are active against gram-positive cocci and highly active against gram-negative bacilli have been the most commonly used agents (8). Ceftriaxone has an antibacterial spectrum similar to that of cefotaxime, but it presents a longer elimination half-life in plasma (8 h) and, apparently, some other pharmacokinetic advantages over cefotaxime (5,12,13). Expanded-spectrum cephalosporins have never been tested in the treatment of cirrhotic SPB, although their in vitro activities against the predominant causative organisms of SBP are excellent (22).…”

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confidence: 99%

Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients

Gómez-Jiménez¹,

Ribera²,

Gasser³

et al. 1993

Antimicrob Agents Chemother

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We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h) for their efficacy and safety in treating spontaneous bacterial peritonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic characteristics were similar in both groups. Ceftriaxonesusceptible strains were isolated on 44 occasions (94%), and cefonicid-susceptible strains were isolated on 43 occasions (91.5%). The antibiotic concentration in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100%Y of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid group and 30%o in the ceftriaxone group (P was not significant). The time that elapsed between the initiation of treatment and the patient's death was shorter in the cefonicid group patients (5.3 ± 3.90 days) than in the ceftriaxone group patients (11.8 ± 9.15 days) (P < 0.05).None of the patients presented with superinfections, and only two patients treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans. Ceftriaxone and cefonicid are safe and useful agents for treating cirrhotic spontaneous bacterial peritonitis, although the pharmacokinetic characteristics of ceftriaxone seem to be more advantageous than those of cefonicid.

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Penetration of Third-Generation Cephalosporins into Human Peritoneal Tissue

Cited by 8 publications

References 10 publications

Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae

Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation

Randomized trial comparing ceftriaxone with cefonicid for treatment of spontaneous bacterial peritonitis in cirrhotic patients

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