Runyon B A, Akriviadis E A, Sattler F R, Cohen J
Department of Medicine, School of Medicine, University of Southern California, Los Angeles.
Dig Dis Sci. 1991 Dec;36(12):1782-6. doi: 10.1007/BF01296625.
Forty-one episodes of ascitic fluid infection were treated with cefotaxime 2 g intravenously every 8 hr, and ascitic fluid and serum were sampled 6, 12, 24, 48, and 96 hr after the first dose of antibiotic. Concentrations of cefotaxime and desacetyl cefotaxime were measured in ascitic fluid and serum by high-performance liquid chromatography. There was essentially 100% penetration of cefotaxime and metabolite from serum into ascitic fluid at all time points. Ascitic fluid was sterilized in 94% of episodes after the first dose of antibiotic. The ascitic fluid concentration of cefotaxime 6 hr after the first dose of antibiotic was greater than 20 times the minimal inhibitory concentration of the drug for 90% of the isolated flora. This rapid ascitic fluid penetration of cefotaxime in high concentration explains the rapid sterilization of ascitic fluid by the drug in the setting of bacterial peritonitis and obviates the need to give a loading dose or intraperitoneal injection.
41例腹水感染患者接受了头孢噻肟治疗，静脉注射剂量为每8小时2g，并在首剂抗生素使用后6、12、24、48和96小时采集腹水和血清样本。通过高效液相色谱法测定腹水和血清中头孢噻肟及去乙酰头孢噻肟的浓度。在所有时间点，头孢噻肟及其代谢产物从血清到腹水的穿透率基本为100%。首剂抗生素使用后，94%的病例腹水被灭菌。首剂抗生素使用6小时后，腹水头孢噻肟浓度超过该药物对90%分离菌群的最低抑菌浓度20倍以上。头孢噻肟在腹水中高浓度的快速穿透解释了该药物在细菌性腹膜炎情况下使腹水快速灭菌的原因，也无需给予负荷剂量或腹腔内注射。
