Cefepime for infections of the biliary tract.

Antibiotic treatment of biliary tract infections is widely accepted. An open, prospective, randomized, multicenter trial comparing cefepime (2 grams every 12 hours) with gentamicin (1.5 milligrams per kilograms every eight hours) plus mezlocillin (3 grams every four hours) for a minimum of five days was undertaken. Of the 149 patients enrolled, 120 were evaluable; 80 were randomized to receive cefepime and 40 were randomized to receive gentamicin plus mezlocillin (two to one randomization schedule). The diagnosis was acute cholecystitis in 101 patients and acute cholangitis in the remainder. There were no differences between the two treatment groups with regard to gender, age, disease, signs and symptoms, admitting temperature or laboratory values. All patients (100 percent) treated with gentamicin and mezlocillin were cured of the infection, as were 78 (97.5 percent) of the patients treated with cefepime (difference not significant). The incidence and spectrum of adverse events and complications were similar between the two groups (8.8 percent for cefepime versus 10 percent for gentamicin and mezlocillin). Our data show that the efficacy and safety of cefepime administered every 12 hours is equivalent to that of gentamicin and mezlocillin combination for treating patients with acute infections of the biliary tract. In addition, twice-daily administration of cefepime may be more cost-effective than the aminoglycoside-based combination.

Gangrenous and/or perforated appendix: clinical outcome and in vitro susceptibility testing.

The data from this study indicate that cefoxitin was effective and generally well tolerated in the management of gangrenous and/or perforated appendicitis. No strong correlation was identified between in vitro susceptibility testing results and clinical outcome.

Effect of preoperative colon preparation on serum potassium.

Although surgeons and anesthesiologists are constantly warned of the danger of hypokalemia following mechanical bowel preparations during the peri- and intraoperative periods, the amount and significance of this problem have not been quantitated. Therefore, the magnitude of the potassium (K+) depletion resulting from three to four days of mechanical bowel preparation was measured in a randomized, prospective fashion in 53 patients. The 27 patients in Group I received intravenous and/or oral potassium chloride supplementation during the preoperative bowel preparation, while the 26 patients in Group II received no supplementation. In an additional five patients, renal and colonic excretory potassium losses were measured to determine if they correlated with preoperative serum potassium levels. All patients had a standard preparation consisting of clear liquid diet (15 mmol K+/day), magnesium citrate orally, enemas, and oral antibiotics. Serum K+ levels in patients in Group I decreased from control levels of 4.01 + 0.41 mmol/1 to 3.71 +/- 0.58 (P less than 0.01) despite an average of 60 mmol potassium chloride supplementation during the preparation. The serum potassium levels in patients in Group II decreased from 4.13 + 0.69 mmol/1 to 3.43 +/- 0.53 (P less than 0.001) during the preparation. Measurement of stool K+ content revealed values that varied considerably between patients and that did not correlate with immediate preoperative serum levels. Urinary K+ measurement showed little renal compensation during the preparation and it did not significantly correlate with preoperative serum levels either.