[Significance of bacterial count of the bile as a criteria of drug efficacy].

ABSTRACT

The effectiveness of antibiotics on biliary tract infections should be evaluated strictly by bacteriological findings rather than clinical results. In this report, the bacteria counts and drug excretion in bile were studied in 4 cases with obstructive jaundice. All patients received cefpiramide (CPM) (1.0 g) by the intravenous administration; before and at 1, 2, 4, 8 and 24 hours after injection, bile samples were taken to measure the CPM concentration (by bioassay) and bacteria counts (by plate count and uricult method). Case 1 After Soupault's operation. The highest peak of CPM excretion in bile was seen after 2 hours; bacteria counts (plate count) were decreased and/or abolished after 4 hours. Case 2 On day 25 after PTCD. CPM showed the highest peak after 1 hour, bacteria counts fell between 3 approximately 5 hours. Case 3 4 months after PTCD. S. faecalis and Streptococcus were gradually diminished but E. cloacae (MIC greater than 100) was almost unchanged. Case 4 Cholangitis with T-tube. No change was seen in A. anitratum though CPM concentration was 830 micrograms/ml. However by the uricult method, bacteria counts decreased from 10(7) to 10(4) on CLED medium, and to 10(3) on MacConkey medium. From these results, the bacteria counts in the bile were correlated to the CPM concentrations 2 hours after it's peak. It was speculated that the decease of bacteria counts reflected the theoretical antibacterial activity.