Keimelimination und Konzentrationsbestimmungen unter Mezlocillin in der Galle bei Gallenwegsinfektionen

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Abstract
A transpapillary indwelling catheter was placed in 15 patients with choledocholithiasis and threatenened occlusion by stone. Ten of the 15 patients had marked biliary stasis, 4 had signs of acute cholangitis. In all patients Escherichia coli was present in the gallbladder in a concentration of .gtoreq. 105/ml when the catheter was first inserted. The bacteria were sensitive to mezlocillin, at a minimal inhibitory concentration between 1.5 and 16 .mu.g/ml. All patients received mezlocillin 5 g twice daily, in a short-term infusion. Immediately before and regularly thereafter bile samples were taken to measure antibiotic concentration and bacterial counts (by membrane filtration). Mezlocillin was excreted in the bile in very high concentrations in patients without biliary stasis, but while the concentrations were markedly lower in those with stasis, they were still 10-100 times the minimum inhibitory concentration of mezlocillin against the appropriate strains. In keeping with the high mezlocillin concentration, bacterial counts fell much more quickly in the patients without stasis than in those with alkaline phosphatase concentration above 250 U/l. These differences were even more marked after 2 or 3 days. Bacterial elimination from bile was complete in 2 of 3 patients with normal alkaline phosphatase activity, but in only 1 of 5 in whom it was elevated.

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