JAC Advance Access originally published online on January 6, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 459-462
© 2003 The British Society for Antimicrobial Chemotherapy
Tissue and serum concentrations of levofloxacin 500 mg administered intravenously or orally for antibiotic prophylaxis in biliary surgery
1 Institute of Hygiene, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg; 2 Pharmacy Department, University of Heidelberg, Im Neuenheimer Feld 670, D-69120 Heidelberg; 3 Department of Surgery, Krankenhaus Salem, Zeppelinstrasse 11–13, D-69121 Heidelberg, Germany
Received 25 June 2002; returned 12 September 2002; revised 16 October 2002; accepted 23 October 2002
Objectives: Levofloxacin is a third-generation fluoroquinolone with a broad spectrum of antibacterial activity, comprising enterobacteria, non-fermenters, Gram-positive cocci and some anaerobic species. Members of these species are common pathogens in acute and chronic cholecystitis. This suggests that levofloxacin may be used as peri-operative prophylaxis in gall-bladder surgery. The purpose of our study was to determine serum and tissue levels of levofloxacin in cholecystectomy patients following pre-operative dosing.
Patients and methods: Patients with gall-bladder surgery were given levofloxacin 500 mg as a single dose either intravenously (iv) or orally pre-operatively, at the treating physician’s decision. Gall-bladder tissue and serum samples were collected, and drug concentrations were determined by HPLC with fluorescence detection. Additionally, all tissue samples underwent routine microbiological diagnostics. MICs for aerobic isolates were determined using the Etest.
Results: A total of 61 patients (48 female, 13 male) were included. The medians of the levofloxacin concentrations in serum were 11.37 mg/L (iv) and 9.65 mg/L (oral), and in gall-bladder tissue they were 15.61 mg/kg (iv) and 17.93 mg/kg (oral). Eleven pathogens were isolated from gall-bladder samples. Post-operative wound infection was observed in two of the 61 patients.
Conclusion: Our data suggest that levofloxacin may be considered for peri-operative prophylaxis in biliary tract surgery.
Keywords: quinolones, pharmacokinetics, pharmacodynamics, cholecystitis, wound infection
* Corresponding author. Tel: +49-6221-56-6635; Fax: +49-6221-56-5343; E-mail: Stefanie_Swoboda{at}med.uni-heidelberg.de
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