title: Effects of biliary obstruction on the penetration of ciprofloxacin and cefotaxime.
abstract: OBJECTIVE
  To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed bile ducts and to determine simple predictive markers of effective biliary concentrations of these drugs.
  
  
  METHODS
  Sixty-two patients treated with endoscopic biliary drainage were prospectively included in a nonrandomized way and received intravenous ciprofloxacin (200 mg twice daily) or cefotaxime (1 g three times a day) for more than 24 h before exploration. Blood and bile samples were collected at the time of drainage. Ciprofloxacin and cefotaxime concentrations were measured using high-performance liquid chromatography. Biliary penetration was assessed by the bile-to-plasma ratio of the concentrations of both antibiotics.
  
  
  RESULTS
  Biliary penetration ranged from 0.06 to 42.7 for ciprofloxacin and from 0.01 to 1.14 for cefotaxime. The ratio was more than one in only 10 patients (35%) and three patients (9%) in ciprofloxacin and cefotaxime groups, respectively. Biliary concentration of the drug was more than 10 times the minimal inhibitory concentration in only 10 patients (35%) and in 12 patients (35%) in ciprofloxacin and cefotaxime groups, respectively. Serum bilirubin, alkaline phosphatase or gamma-glutamyl-transpeptidase were not good predictive markers of the biliary diffusion of the antibiotics.
  
  
  CONCLUSIONS
  In patients with obstructed bile ducts, the biliary penetration of ciprofloxacin is poor and reaches effective biliary concentrations in a minority of patients. Cefotaxime biliary penetration is even poorer. No liver test can predict accurately the biliary penetration of the drugs.
authors.affiliation: Hepatology, Le Kremlin Bicêtre, France. valerie.dhalluin@bct.aphp.fr
authors.forename: Valérie
authors.initials: V
authors.lastname: Dhalluin-Venier
authors.forename: Christophe
authors.initials: C
authors.lastname: Bazin
authors.forename: Laurent
authors.initials: L
authors.lastname: Massias
authors.forename: Rita Bou
authors.initials: RB
authors.lastname: Farah
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boytchev
authors.forename: Jacques
authors.initials: J
authors.lastname: Fritsch
authors.forename: André-Daniel
authors.initials: AD
authors.lastname: Choury
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
authors.forename: Catherine
authors.initials: C
authors.lastname: Buffet
authors.forename: Valérie
authors.initials: V
authors.lastname: Furlan
authors.forename: Gilles
authors.initials: G
authors.lastname: Pelletier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001646:Bile / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D002439:Cefotaxime / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D002779:Cholestasis / Q000209:etiology / Q000378:metabolism* / Q000601:surgery; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D002939:Ciprofloxacin / Q000493:pharmacokinetics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002439:Cefotaxime; D001663:Bilirubin