ANTIBIOTICS, BILIARY SEPSIS, AND BILE-DUCT STONES

Bacteriologic studies of bile and blood cultures of 579 patients with ductal stones and infected bile revealed that 121 patients (21%) had a ssociated bacteremia. Analysis of bile and stone cultures showed that Escherichia coli, Klebsiella sp, Enterobacter sp, Enterococcus sp, and Streptococcus sp were the most commonly isolated bacteria. Two-thirds of the patients with bacteremia had similar organisms isolated from b lood and bile. Pharmacokinetic studies of the hepatic/biliary excretio n profiles of ceftazidime, cefoperazone, imipenem, netilmicin, and cip rofloxacin were performed by ERCP and nasobiliary catheter drainage. T he bile samples obtained immediately after cannulation from patients w ith complete biliary obstruction contained low or undetectable levels of the antibiotics administered-the exception being ciprofloxacin, whi ch was present at a concentration of 20% of the serum level. In vitro determination of minimum inhibitory concentration of the aforementione d antibiotics against 199 isolates of biliary pathogens revealed imipe nem and ciprofloxacin to have the highest antimicrobial activity. Base d on pharmacokinetic studies and in vitro susceptibility findings, we conclude that ciprofloxacin is superior to the other tested antibiotic s in prophylaxis and treatment of biliary sepsis.