Cefoperazone compared with ampicillin plus tobramycin for severe biliary tract infections

Abstract

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

Pharmacokinetics of Cefoperazone and Sulbactam in Liver Transplant Patients

“…1 The use of sulbactam, a beta-lactamase inhibitor, in conjunction with cefoperazone expands the antimicrobial spectrum of cefoperazone and increases the activity against gram-negative anaerobes. 2 Both cefoperazone and sulbactam have been used exten-sively in humans, 3,4 and the pharmacokinetics of both drugs is not altered when they are administered in combination. Limited information is available, however, on the pharmacokinetics of cefoperazone or sulbactam in liver transplant patients.…”

Quantitative determination of unbound cefoperazone in rat bile using microdialysis and liquid chromatography

“…1) is a third generation cephalosporin antibiotic with a board spectrum of activity against grampositive and gram-negative bacteria [1]. It is clinically effective in the treatment of infections in the biliary tract [2,3]. The ideal drug for the treatment of biliary tract infection should have excellent effects against potential biliary pathogens and should easily penetrate and be concentrated in the biliary tree [4,5].…”

“…It can also provide a unique way to obtain near-complete concentration profiles of drugs in anatomically clearly defined tissues and organs. Cefoperazone levels in different tissues have been determined previously by microbiological methods [3,18] or HPLC [18][19][20][21][22]. Some of the HPLC assays with different extraction techniques have been extensively applied to pharmacokinetic studies [22,23].…”