title: Effect of cardiogenic shock on pharmacokinetics and tissue distribution of ampicillin-sulbactam.
abstract: A reversible cardiogenic shock model in pigs investigated shock-induced changes in the pharmacokinetics and tissue distribution of ampicillin-sulbactam and the efficacy of this antibiotic regimen in eliminating enteric bacterial translocation. Sixteen pigs were randomly allocated to 3 groups: group I (shock, ampicillin-sulbactam, n = 6), group II (no shock, ampicillin-sulbactam, n = 6), and group III (shock, no ampicillin-sulbactam, n = 4). Nalidixic acid-resistant E. coli (60 x 10(6) CFU) were instilled into a jejunal loop created in each pig, and bacterial cultures were taken from thoracic duct lymph, periportal, and mesenteric lymph nodes. Ampicillin-sulbactam was administered intravenously at a standard dose of 3 g. Results showed that 1) ampicillin and sulbactam concentrations generally increase during cardiogenic shock; 2) cardiogenic shock does not increase ampicillin concentrations in jejunum and liver; 3) during resuscitation, thoracic duct lymph ampicillin concentrations decrease; and 4) during and immediately after cardiogenic shock, standard doses of ampicillin-sulbactam appear efficacious in eliminating translocated bacteria.
authors.affiliation: Division of General Surgery, University of Kentucky, College of Medicine, Lexington, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Arden
authors.forename: D E
authors.initials: DE
authors.lastname: Barker
authors.forename: W E
authors.initials: WE
authors.lastname: Strodel
authors.forename: K
authors.initials: K
authors.lastname: Record
authors.forename: G
authors.initials: G
authors.lastname: Leader
authors.forename: M
authors.initials: M
authors.lastname: Derbin
authors.forename: G
authors.initials: G
authors.lastname: Gellin
authors.forename: R W
authors.initials: RW
authors.lastname: Schwartz
mesh_terms: D000667:Ampicillin / Q000493:pharmacokinetics / Q000627:therapeutic use; D000818:Animals; D001202:Ascitic Fluid / Q000378:metabolism; D001419:Bacteria / Q000302:isolation & purification; D002302:Cardiac Output; D004359:Drug Therapy, Combination / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D007413:Intestinal Mucosa / Q000378:metabolism; D008099:Liver / Q000378:metabolism; D008168:Lung / Q000378:metabolism; D008196:Lymph / Q000378:metabolism / Q000382:microbiology; D008198:Lymph Nodes / Q000382:microbiology; D008643:Mesentery; D011168:Portal System / Q000378:metabolism / Q000382:microbiology; D012770:Shock, Cardiogenic / Q000378:metabolism* / Q000382:microbiology; D013407:Sulbactam / Q000493:pharmacokinetics / Q000627:therapeutic use; D013552:Swine; D014018:Tissue Distribution
chemical_list: C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam