title: Prophylaxis with ertapenem in patients with obstructive jaundice undergoing endoscopic retrograde cholangiopancreatography: safety, efficacy, and biliary penetration.
abstract: BACKGROUND
  Cholangitis and biliary sepsis are rare but serious complications of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to investigate the safety, efficacy, and biliary penetration of ertapenem, a newer carbapenem with a long half-life and broad-spectrum antimicrobial activity, for ERCP prophylaxis.
  
  
  METHODS
  Patients with obstructive jaundice without cholangitis received a single dose of ertapenem equal to 1 gram intravenously prior to ERCP. A 2-3 mL bile sample was collected after cannulation and prior to contrast injection. Patients were observed for 72 hours for cholangitis or drug-related adverse events. Biliary ertapenem levels were measured using high-performance liquid chromatography (HPLC).
  
  
  RESULTS
  Twenty-eight patients (ages 18-87 years, M/F ratio 1:1) were enrolled. Seven had no cholestasis and were included to study ertapenem penetration in unobstructed biliary trees. Cannulation was achieved in all patients. One patient (3.6%) with persistent intrahepatic stones developed cholangitis. No drug-related adverse events were noted. The mean time from ertapenem administration to bile collection was 60 ± 24 minutes. There was a significant negative correlation between serum bilirubin and biliary ertapenem levels (r = -0.542, P = 0.003) with the highest level (6.25 μg/mL) noted in unobstructed biliary systems.
  
  
  CONCLUSIONS
  Ertapenem appears to be a safe and effective prophylaxis in patients with obstructive jaundice undergoing ERCP despite a limited biliary penetration in patients with high-grade obstruction.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mroueh
authors.forename: Soula Boustany
authors.initials: SB
authors.lastname: Kyriacos
authors.forename: Heitham
authors.initials: H
authors.lastname: Abdul-Baki
authors.forename: Hani F
authors.initials: HF
authors.lastname: Chaar
authors.forename: Elie
authors.initials: E
authors.lastname: Aoun
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Nabil M
authors.initials: NM
authors.lastname: Mansour
authors.forename: Souha S
authors.initials: SS
authors.lastname: Kanj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001659:Biliary Tract / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000209:etiology / Q000517:prevention & control; D000077727:Ertapenem; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult; D047090:beta-Lactams / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077727:Ertapenem