Pharmacokinetics of cefepime in bile and gall bladder tissue after prophylactic administration in patients with extrahepatic biliary diseases

The purpose of this study was to determine the cefepime concentrations in serum, bile and gall bladder tissue after administration of a single dose in patients with extrahepatic biliary diseases for pre-operative antimicrobial prophylaxis. During a 3-year period (1999–2002), 30 patients aged above 18 years with extrahepatic biliary diseases (acute and chronic cholecystitis and symptomatic cholelithiasis) were included in the study. Cefepime concentrations were determined by the agar microbiological diffusion method. A significant correlation between serum and gall bladder tissue concentrations of cefepime with the sampling interval was observed (r2 = 0.771, P < 0.0001), whereas no correlation between serum and bile fluid concentrations of the drug was noted. In patients with non-functioning gall bladder, very low tissue levels of cefepime were detected. During the time of surgery, serum and gall bladder tissue concentrations of cefepime exceeded the minimum inhibitory concentration for 90% of the organisms (MIC90) for most common pathogens. Cefepime has the required pharmacokinetic properties to be considered for pre-operative antimicrobial prophylaxis in patients undergoing biliary tract surgery.