Studies of the Intraperitoneal Antibiotic Administration

Takashi Kodama, Takashi Yokoyama*, Yoshio Takesue, Mitsuaki Okita, Atsushi Nakamitsu, Eiso Hiyama*, Yuuji Imamura, Takahiro Santo, Yoshiaki Murakami, Hiroaki Tsumura, Toshiaki Hirata, Katsunari Miyamoto, Naokuni Tatsumoto, Yuichirou Matsuura

First Department of Surgery, *Department of General Medicine, Hiroshima University School of Medicine

The value of intraperitoneal antibiotics to prevent postoperative infections was evaluated. The pharmacokinetics of 3 cephems (cefotiam, flomoxef, sulbactum/cefoperazone) were examined in patients undergoing gastroenterological surgery were examined. Patients received 1 g of cephem intravenously (DI) or intraperitoneally (IP) at the beginning of the operation. Thirty minutes after IP administration, the mean intraperitoneal fluid antibiotic level was 1000 µg/ml, and it was 300 µg/ml after 1 hour. Thirty minutes and 1 hour after administration each intraperitoneal fluid level in the IP group was significantly higher than that in the DI group. But 4 and 6 hours after administration the levels were the same. These results showed a high intraperitoneal fluid level was obtained in the IP group, but the amount of time exceeding the therapeutic intraperitoneal fluid level was not maintained compared with the DI group. The bactericidal activity of flomoxef (FMOX) against Escherichia coli sensitive to this antibiotics was dependent on the doses (400, 40, 4 µg/ml). The production of endotoxin at a high antibiotic dose was less than that in controls which had no antibiotic administration. In saline where Escherichia coli even 400 µg/ml of FMOX 30 had no bactericidal activity against Escherichia coli. No bactericidal activity against resistant strains such as Pseudomonas aeruginosa or methicillin resistant Staphylococcus aureus was obtained at 400 µg/ml of. FMOX. These studies lead to the speculation that the intraperitoneal fluid level and the amount of time exceeding the therapeutic level after PI administration has little efficacy in reducing the postoperative abdominal sepsis after peritonitis.

Key words
topical antibitic administration, intraperitoneal administration, pharmacokinetics, bactericidal activity, endotoxin

Reprint requests
Takashi Kodama First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minamiku, Hiroshima, 734 JAPAN

Accepted
October 13, 1993

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