The peritoneal cavity contained 900 ml of straw coloured fluid and there was a generalised serositis of the infracolic compartment. The liver was normal and apart from inflammation of their covering serosa, the appendix, uterus and fallopian tubes appeared normal. There were widespread tenacious adhesions between adjacent loops of small bowel with adhesive obstruction of the mid ileum. Peritoneal fluid was submitted for routine bacterial culture whilst swabs from the fallopian tubes and cervix were sent for routine culture and the isolation of chlamydia. The obstruction was relieved, appendicectomy was performed and the peritoneal cavity was lavaged with a solution of tetracycline (1 gm/l).No pathogens were grown on routine culture and unfortunately the swabs for chlamydial culture were inadvertently sent in virus transport medium, culture was not attempted. However, the swabs from the fallopian tubes and cervix were strongly positive for chlamydia when tested by ELISA (IDEIA Mark 2
Cefotetan excretion was studied in 17 patients undergoing biliary or pancreatic surgery. The antibiotic was detected in bile taken from the common bile duct within 15 min of a 1 g iv bolus and therapeutic plasma levels were found up to 10 h after administration. Even higher concentrations of cefotetan were measured in the bile from functioning gall bladders, despite the presence of gall stones. Concentrations of cefotetan in bile from the common bile ducts and functioning gall bladders were greater than the plasma concentrations at all times. These concentrations exceed the in-vitro minimum inhibitory concentrations (MIC) for most common biliary tract pathogens.
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