Investigation of the biliary clearances of cefotaxime and desacetylcefotaxime by an original procedure in cholecystectomised patients

The biliary elimination of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) were measured by HPLC in nine recently cholecystectomised patients following the i. v. injection of 15 mg/kg body weight of CTX. All of the bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube. Biliary clearance of CTX and DSCTX was measured for 8 h. Cefotaxime peaked at 90 min after injection at 34.5 ± 15.3 mg/l; in the 7–8 h sample it was 2.7 ± 1.7 mg/l. DSCTX peaked at the same time at 49.3 ± 17.0 mg/l, and was 4.6 ± 3.2 mg/l at 8 h. The bile/serum ratio of CTX and DSCTX concentrations was above 1 from the first to the eighth hours (range: 1.35 ± 1.08 to 11.0 ± 3.1). The biliary clearance of CTX was 0.190 ml/min. The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 ± 472.8 µg and 1902.7 ± 804.1 µg (0.093 ± 0.041% of the dose and 0.186 ± 0.077% of the dose). Considering the minimum inhibitory concentration of the pathogens currently encountered in biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.