EFFECT OF CARDIOGENIC-SHOCK ON PHARMACOKINETICS AND TISSUE DISTRIBUTION OF AMPICILLIN-SULBACTAM

A reversible cardiogenic shock model in pigs investigated shock-induce d changes in the pharmacokinetics and tissue distribution of ampicilli n-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 ampic illin-sulbactam, n = 4). Nalidixic acid-resistant E. coil (60 x 10(6) CFU) were instilled into a jejunal loop created in each pig, and bacte rial cultures were taken from thoracic duct lymph, periportal, and mes enteric lymph nodes. Ampicillin-sulbactam was administered intravenous ly at a standard dose of 3 g. Results showed that 1) ampicillin and su lbactam concentrations generally increase during cardiogenic shock; 2) cardiogenic shock does not increase ampicillin concentrations in jeju num and liver; 3) during resuscitation, thoracic duct lymph ampicillin concentrations decrease; and 4) during and immediately after cardioge nic shock, standard doses of ampicillin-sulbactam appear efficacious i n eliminating translocated bacteria. (c) 1995 Wiley-Liss, Inc.