The effect of biliary decompression on antibiotic biliary excretion.
OBJECTIVE
Raised biliary pressure may affect antibiotic biliary excretion. We evaluated whether biliary decompression for patients with biliary obstruction could improve antibiotic biliary excretion.


METHODS
Eight patients with common bile duct obstruction undergoing endoscopic nasobiliary drainage were evaluated. During endoscopic cannulation, biliary pressure above the obstruction and antibiotic concentrations in the bile and peripheral blood were determined 60 min after the intravenous antibiotic (panipenem) administration.


RESULTS
Biliary pressure was initially elevated above normal in all the patients, but normalized after biliary drainage for 5 to 7 days. At the initial endoscopic retrograde cholangiopancreatography, the aspirated bile contained low or undetectable levels of the antibiotic, but the mean bile panipenem concentration and the mean bile/plasma ratio of panipenem concentrations significantly improved after biliary decompression.


CONCLUSIONS
The results suggest an important role of biliary pressure in determining antibiotic transfer into the bile.
Yamamoto
Shin
S
Third Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8506, Japan.
Kubota
Yoshitsugu
Y
Takaoka
Makoto
M
Ogura
Mami
M
Tsuji
Kazuyuki
K
Yanagitani
Kaori
K
Shimatani
Masaaki
M
Shibatani
Nobuyuki
N
Imai
Yoshihito
Y
Takamidoh
Shoichiroh
S
Inoue
Kyoichi
K
D000368:Aged; D001646:Bile / Q000378:metabolism*; D001652:Bile Ducts / Q000378:metabolism*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000378:metabolism* / Q000601:surgery*; D019299:Decompression, Surgical; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D013845:Thienamycins / Q000493:pharmacokinetics*
D013845:Thienamycins; C039536:panipenem