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Prophylaxis with Ertapenem in Patients with Obstructive Jaundice Undergoing Endoscopic Retrograde Cholangiopancreatography: Safety, Efficacy, and Biliary Penetration.
MedLine Citation:
PMID:  21297547     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Cholangitis and biliary sepsis are rare but serious complications of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to investigate the safety, efficacy, and biliary penetration of ertapenem, a newer carbapenem with a long half-life and broad-spectrum antimicrobial activity, for ERCP prophylaxis. METHODS:: Patients with obstructive jaundice without cholangitis received a single dose of ertapenem equal to 1 gram intravenously prior to ERCP. A 2-3 mL bile sample was collected after cannulation and prior to contrast injection. Patients were observed for 72 hours for cholangitis or drug-related adverse events. Biliary ertapenem levels were measured using high-performance liquid chromatography (HPLC). RESULTS:: Twenty-eight patients (ages 18-87 years, M/F ratio 1:1) were enrolled. Seven had no cholestasis and were included to study ertapenem penetration in unobstructed biliary trees. Cannulation was achieved in all patients. One patient (3.6%) with persistent intrahepatic stones developed cholangitis. No drug-related adverse events were noted. The mean time from ertapenem administration to bile collection was 60 ± 24 minutes. There was a significant negative correlation between serum bilirubin and biliary ertapenem levels (r = -0.542, P = 0.003) with the highest level (6.25 μg/mL) noted in unobstructed biliary systems. CONCLUSION:: Ertapenem appears to be a safe and effective prophylaxis in patients with obstructive jaundice undergoing ERCP despite a limited biliary penetration in patients with high-grade obstruction.
Authors:
Ala I Sharara; Ihab I El Hajj; Mohammad Mroueh; Soula Boustany Kyriacos; Heitham Abdul-Baki; Hani F Chaar; Elie Aoun; Jana G Hashash; Nabil M Mansour; Souha S Kanj
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-3
Journal Detail:
Title:  Southern medical journal     Volume:  -     ISSN:  1541-8243     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404522     Medline TA:  South Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon; School of Pharmacy, Lebanese American University, Jbeil, Lebanon; and Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
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