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Antimicrobial Agents and Chemotherapy, May 1998, p. 1093-1097, Vol. 42, No. 5
Department of Anesthesia and Intensive Care,
Received 26 February 1997/Returned for modification 16 September
1997/Accepted 10 February 1998
The concentrations of sulbactam and ampicillin were determined in
sera and different abdominal tissues of 16 patients who underwent
elective colorectal surgery. Patients were randomly allocated to two
groups. At the time of induction of anesthesia, patients in group 1 (eight patients) were given 1,000 mg of sulbactam with 2,000 mg of
ampicillin by intravenous bolus injection (3 min). This dose was
administered again after 2 h by bolus injection by the same route.
Patients in group 2 (eight patients) were given the same initial dose
of sulbactam-ampicillin by bolus injection (3 min). Then, a continuous
infusion of 1,000 mg of sulbactam with 2,000 mg of ampicillin in normal
saline was immediately started and was administered over a 4-h period.
Blood samples were collected to determine peak (10 min) and trough (end
of surgery) antibiotic levels. Serial blood samples were also collected
at predetermined periods (at the time of opening and closing of the
abdominal cavity and at the time of surgical anastomosis). Abdominal
wall fat, epiploic fat, and colonic wall tissue samples were collected
simultaneously. Antibiotic concentrations were determined by
high-performance liquid chromatography. Similar levels of the drugs in
serum were observed for the two regimens of administration, with trough
sulbactam levels of 33 ± 16 and 37 ± 22 µg/ml in groups 1 and 2, respectively, and trough ampicillin levels of 72 ± 55 and
79 ± 47 µg/ml in groups 1 and 2, respectively. Similar
sulbactam concentrations were observed in abdominal tissues whichever
regimen of administration was used; in fatty tissues the sulbactam
concentrations ranged from 2.7 to 3.8 µg/g for group 1 and from 1.7 to 4.0 µg/g for group 2, and sulbactam concentrations in the colonic
wall were 5.6 ± 7.7 and 6.8 ± 3.2 µg/g in groups 1 and 2, respectively (not significant). Again, no influence of the regimen of
administration was observed on tissue ampicillin concentrations; in
fatty tissues ampicillin concentrations ranged from 4.1 to 5.4 µg/g
for group 1 and from 3.2 to 5.8 µg/g for group 2, and sulbactam
concentrations in the colonic wall were 7.0 ± 2.8 and 11.0 ± 4.7 µg/g for groups 1 and 2, respectively (not significant). In
most patients, the concentrations of ampicillin-sulbactam were greater
than the MIC at which 50% of isolates are inhibited
(MIC50) for Bacteroides fragilis in the fatty
tissues. In the colonic wall, for most patients the concentrations of
ampicillin-sulbactam were greater than the MIC90 for
B. fragilis. No influence of the regimen of administration was observed on the ratio of the two components in the tissues investigated and in sera. In conclusion, a second intraoperative bolus
injection or a continuous infusion were equally effective in
maintaining sulbactam-ampicillin concentrations in abdominal tissues.
The first method of administration can be recommended since it is
easier to handle.
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Comparison of Concentrations of
Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus
Continuous Infusion in Tissues of Patients Undergoing Colorectal
Surgery
*
Corresponding author. Mailing address:
Département d'Anesthésie, Hôpital Nord, 13915 Marseille Cedex 20, France. Phone: 33-491-96-86-50. Fax:
33-491-96-28-18. E-mail: cmartin{at}ap-hm.fr.
Antimicrobial Agents and Chemotherapy, May 1998, p. 1093-1097, Vol. 42, No. 5
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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