Gerding D N, Hall W H, Schierl E A
Ann Intern Med. 1977 Jun;86(6):708-13. doi: 10.7326/0003-4819-86-6-708.
Thirty-six paired specimens of serum and ascitic fluid from 21 patients with peritonitis and ascites, most with sponetaneous bacterial peritonitis and alcoholic cirrhosis, were assayed for antibiotic content. Antibiotics assayed and number of determinations were gentamicin, 14; tobramycin, 7; ampicillin, 5; clindamycin, 3; penicillin G, 2; cephalothin, 2; chloramphenico, 2; and cefazolin, 1. In 31 pared specimens the ascitic fluid antibiotic concentration was about one half or more of the simultaneous serum level and in 17 assays exceeded 90% of the serum level. All antibiotics studied penetrated ascitic fluid equally well. Clinical response to antibiotic therapy was good in 12 of 16 patients with culture-proven bacterial peritonitis. Antibiotic levels in ascitic fluid exceeded the minimal inhibitory concentration of the infecting organisms in all but one patient who responded. Direct intraperitoneal instillation of antibiotics does not appear to be necessary routinely; however, there may be an initial lag of several hours before antibiotic concentrations is ascites achieve therapeutic levels.
对21例患有腹膜炎和腹水的患者（大多数患有自发性细菌性腹膜炎和酒精性肝硬化）的36对血清和腹水标本进行了抗生素含量检测。检测的抗生素及测定次数如下：庆大霉素，14次；妥布霉素，7次；氨苄西林，5次；克林霉素，3次；青霉素G，2次；头孢噻吩，2次；氯霉素，2次；头孢唑林，1次。在31对标本中，腹水抗生素浓度约为同时期血清水平的一半或更高，在17次检测中超过血清水平的90%。所有研究的抗生素穿透腹水的效果相同。在16例经培养证实患有细菌性腹膜炎的患者中，12例对抗生素治疗的临床反应良好。除1例有反应的患者外，所有患者腹水中的抗生素水平均超过感染菌的最低抑菌浓度。常规情况下似乎没有必要直接腹腔内注入抗生素；然而，腹水抗生素浓度达到治疗水平之前可能会有几个小时的初始延迟。
