Pharmacokinetics and Clinical Efficacy of Moxalactam in Biliary Tract Infections

Mueller, Oliver; Fabricius, Katrine; Krueger, Erich G.; Rueckert, U.

doi:10.1093/clinids/4.supplement_3.s688

Cited by 5 publications

(1 citation statement)

References 4 publications

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“…Patients with severe, complicated biliary tract infections responded favourably to the administration of latamoxef (Mueller et al, 1982). The concentration of the drug in the bile paralleled those found in serum but were usually higher.…”

Section: Latamoxejmentioning

confidence: 94%

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: Latamoxejmentioning

confidence: 94%

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Balant

Dayer

Auckenthaler

1985

Clinical Pharmacokinetics

106

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Empiric Therapy With Moxalactam Alone in Patients With Bacteremia

Wilson¹,

Henry²,

Keys

et al. 1984

Mayo Clinic Proceedings

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Cefoperazone compared with ampicillin plus tobramycin for severe biliary tract infections

Bergeron

Mendelson

Harding

et al. 1988

Antimicrob Agents Chemother

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In a prospective, randomized, multicenter study, the efficacy and safety of cefoperazone and the combination ampicillin-tobramycin as initial therapy for patients with severe acute biliary tract infections were compared. Of 77 patients initially entered in the study, definite severe biliary tract infection was confirmed in 67. Sixty-four patients completed treatment. At the end of treatment, 35 of 36 (97%) patients given cefoperazone and 23 of 28 (82%) given ampicillin-tobramycin were cured of their infection (P = 0.07). Pathogens were recovered from the bile in 32 patients; microbiological cures were observed in 18 of 19 (94%) patients receiving cefoperazone and 8 of 13 (62%) receiving ampicillin-tobramycin (P = 0.03). Thirteen patients had septicemia. None (0%) of the eight septicemic patients from the cefoperazone group, but two of five (40%) from the ampicillin-tobramycin group, were clinical failures. Of the isolated pathogens, 51% were resistant to ampicillin, while the resistance rate was 4% for tobramycin and 1% for cefoperazone (P < 0.001). Biliary concentrations of cefoperazone were maintained at high levels-236 ± 87

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Pharmacokinetics and Clinical Efficacy of Moxalactam in Biliary Tract Infections

Cited by 5 publications

References 4 publications

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Clinical Pharmacokinetics of the Third Generation Cephalosporins

Empiric Therapy With Moxalactam Alone in Patients With Bacteremia

Cefoperazone compared with ampicillin plus tobramycin for severe biliary tract infections

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