Penetration of sulbactam-ampicillin and clavulanic acid-amoxicillin into the pelvic peritoneum

Houang, Elizabeth T.; Colley, Noriyo; Chapman, Michael

doi:10.1128/aac.28.1.165

Cited by 16 publications

(3 citation statements)

References 4 publications

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“…The data for clavulanic acid (200 mg) and amoxicillin (2,000 mg) are in agreement with results previously reported (7,9,12,27). Specific differences between tissues and the two compounds were observed.…”

Section: Discussionsupporting

confidence: 81%

Comparison of concentrations of two doses of clavulanic acid (200 and 400 milligrams) administered with amoxicillin (2,000 milligrams) in tissues of patients undergoing colorectal surgery

Martin

Mallet

Sastre

et al. 1995

Antimicrob Agents Chemother

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The concentrations of clavulanic acid and amoxicillin were determined in sera and different abdominal tissues of 17 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 were given 200 mg of clavulanic acid with 2,000 mg of amoxicillin and patients in group 2 received 400 mg of clavulanic acid with 2,000 mg of amoxicillin. In both groups, the initial dose was administered again after 2 h. Blood samples were collected to determine peak and trough antibiotic levels. Serial blood samples were also collected at predetermined periods (opening and closure of the abdominal cavity and surgical anastomosis). Abdominal wall fat, epiploic fat, and colonic wall tissue samples were collected simultaneously. Antibiotic concentrations were determined by high-performance liquid chromatography. Increasing the dose of clavulanic acid to 400 mg resulted in significantly higher peak and trough levels in serum (P < 0.03). Following the injection of 400 mg, mean concentrations of clavulanic acid in the fatty tissues were significantly increased at the time of opening (P < 0.02). The concentrations of clavulanic acid and amoxicillin in fatty tissues were 17 to 52% and 12 to 23% of the levels in sera, respectively. In the colonic wall, the concentrations of clavulanic acid and amoxicillin were 52 to 63% and 49 and 27% of the levels in sera, respectively. In sera, clavulanic acid given at a dose of 200 or 400 mg reached or exceeded the concentrations found to be effective in vitro to reduce the MICs of amoxicillin from the resistant to the susceptible category for 90% of the potential pathogens. In most of the tissues investigated, increasing the dose of clavulanic acid to 400 mg resulted in a significantly higher number of samples with concentrations found to be effective in vitro (72 versus 11%; P < 0.05). In conclusion, increasing the dose of clavulanic acid to 400 mg resulted in higher levels in sera and improved penetration into the abdominal tissues in patients undergoing colorectal surgery.

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Section: Discussionsupporting

confidence: 81%

Comparison of concentrations of two doses of clavulanic acid (200 and 400 milligrams) administered with amoxicillin (2,000 milligrams) in tissues of patients undergoing colorectal surgery

Martin

Mallet

Sastre

et al. 1995

Antimicrob Agents Chemother

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“…Penetration was evaluated by measuring the concentration in tissue-to-concentration in plasma ratios at specific collection times. The data for sulbactam and ampicillin are in agreement with results reported previously (11,13,14). Specific differences between tissues were observed.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Concentrations of Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus Continuous Infusion in Tissues of Patients Undergoing Colorectal Surgery

Martin

Cotin

Giraud

et al. 1998

Antimicrob Agents Chemother

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The concentrations of sulbactam and ampicillin were determined in sera and different abdominal tissues of 16 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 (eight patients) were given 1,000 mg of sulbactam with 2,000 mg of ampicillin by intravenous bolus injection (3 min). This dose was administered again after 2 h by bolus injection by the same route. Patients in group 2 (eight patients) were given the same initial dose of sulbactam-ampicillin by bolus injection (3 min). Then, a continuous infusion of 1,000 mg of sulbactam with 2,000 mg of ampicillin in normal saline was immediately started and was administered over a 4-h period. Blood samples were collected to determine peak (10 min) and trough (end of surgery) antibiotic levels. Serial blood samples were also collected at predetermined periods (at the time of opening and closing of the abdominal cavity and at the time of surgical anastomosis). Abdominal wall fat, epiploic fat, and colonic wall tissue samples were collected simultaneously. Antibiotic concentrations were determined by high-performance liquid chromatography. Similar levels of the drugs in serum were observed for the two regimens of administration, with trough sulbactam levels of 33 ± 16 and 37 ± 22 μg/ml in groups 1 and 2, respectively, and trough ampicillin levels of 72 ± 55 and 79 ± 47 μg/ml in groups 1 and 2, respectively. Similar sulbactam concentrations were observed in abdominal tissues whichever regimen of administration was used; in fatty tissues the sulbactam concentrations ranged from 2.7 to 3.8 μg/g for group 1 and from 1.7 to 4.0 μg/g for group 2, and sulbactam concentrations in the colonic wall were 5.6 ± 7.7 and 6.8 ± 3.2 μg/g in groups 1 and 2, respectively (not significant). Again, no influence of the regimen of administration was observed on tissue ampicillin concentrations; in fatty tissues ampicillin concentrations ranged from 4.1 to 5.4 μg/g for group 1 and from 3.2 to 5.8 μg/g for group 2, and sulbactam concentrations in the colonic wall were 7.0 ± 2.8 and 11.0 ± 4.7 μg/g for groups 1 and 2, respectively (not significant). In most patients, the concentrations of ampicillin-sulbactam were greater than the MIC at which 50% of isolates are inhibited (MIC50) for Bacteroides fragilis in the fatty tissues. In the colonic wall, for most patients the concentrations of ampicillin-sulbactam were greater than the MIC90 forB. fragilis. No influence of the regimen of administration was observed on the ratio of the two components in the tissues investigated and in sera. In conclusion, a second intraoperative bolus injection or a continuous infusion were equally effective in maintaining sulbactam-ampicillin concentrations in abdominal tissues. The first method of administration can be recommended since it is easier to handle.

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“…Amoxycillin/ clavulanate is active against Neisseria gonorrhoeae (including /Mactamase-producing strains) and Gram-positive and Gram-negative anaerobes (including Bacteroides fragilis). Both amoxycillin and clavulanate have been shown to penetrate readily into the pelvic peritoneal cavity (Houang, Colley & Chapman, 1985).…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of amoxycillin/clavulanate in laparoscopically confirmed salpingitis

Obwegeser¹,

Kunz²,

Wüst³

et al. 1989

Journal of Antimicrobial Chemotherapy

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To test the efficacy and safety of amoxycillin/clavulanate (Augmenting 102 hospital patients with laparoscopically confirmed acute salpingitis were treated with parenteral amoxycillin/clavulanate (l-2g qid for three days) followed by oral amoxycillin/ clavulanate (two tablets of 625 mg tid for a further six days). Bacteriological samples were obtained from the cervix uteri and the pouch of Douglas. One hundred patients were assessable for clinical outcome using several variables including pain scores. Amoxycillin/clavulanate alone was effective in 95 patients (95%). Three patients (3%) responded to amoxycillin/clavulanate with marked improvement but another antibiotic was subsequently added to their treatment regimen. Treatment failed in two patients. At follow-up two weeks after hospital discharge, three patients (3-8%) had relapsed or were re-infected. Adverse drug events included one case of drug fever, one case of rash and one case of severe diarrhoea. Treatment was stopped in all three cases. Gastrointestinal reactions, mainly mild diarrhoea, were seen in 31 patients. No clinically relevant changes in haematological or clinical chemical indices were attributable to the amoxyciUin/clavulanatc treatment. We conclude that amoxycillin/clavulanate is a clinically effective and safe treatment for acute salpingitis.

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Penetration of sulbactam-ampicillin and clavulanic acid-amoxicillin into the pelvic peritoneum

Cited by 16 publications

References 4 publications

Comparison of concentrations of two doses of clavulanic acid (200 and 400 milligrams) administered with amoxicillin (2,000 milligrams) in tissues of patients undergoing colorectal surgery

Comparison of concentrations of two doses of clavulanic acid (200 and 400 milligrams) administered with amoxicillin (2,000 milligrams) in tissues of patients undergoing colorectal surgery

Comparison of Concentrations of Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus Continuous Infusion in Tissues of Patients Undergoing Colorectal Surgery

Clinical efficacy of amoxycillin/clavulanate in laparoscopically confirmed salpingitis

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