The effect of biliary decompression on antibiotic biliary excretion.

Background Aims: Raised biliary pressure may affect antibiotic biliary excration, We evaluated whether biliary decompression for patients with billary obstruction could improve antibiotic biliary excration. Methodology: Eight patients with common bile duct obstruction endergoing endoscopic nasobiliary drainage were evaluated. During endoscopic cannulation, biliary pressure above the obstruction and antibiotic concentrations in the bile and peripheral blood were determined 60min after the intravenous antibiotic (panipenem) administration. Results: Biliary pressure was initially elevated above normal in all the patients, but normalized after biliary drainage for 5 to 7 days. At the initial endoscopic retrogrede cholangiopancreatography, the aspirated bile contained low or undetectable levels of the antibiotic, but the mean bile panipenum concentration and the mean bile/plasma ratio of panipenem concentrations significantly improved after biliary decompression. Conclusions: The results suggest an important role of biliary pressure in determining antibiotic transfer into the bile.