Use of ceftazidime in hepatobiliary surgery.

Abstract

Patients undergoing hepato-biliary surgery pose both diagnostic and therapeutic challenges. Such operations are commonly seen in Asian countries and especially in the Southern parts of Taiwan. Biliary pathogens are usually noticed when the disease coexists with gallstones. Bile stasis with bacterial infection predisposing to longstanding intermittent obstructive jaundice, cholangitis, liver abscess and septicemia results in high morbidity and mortality. Treatment is generally initiated with broad-spectrum antibiotics before operative intervention and culture results become available. The usual therapeutic regimen incudes beta-lactam agents with or without aminoglycoside. A clinical efficacy study was conducted using a single agent, ceftazidime, to treat twenty adults who underwent hepato-biliary surgery. Fiteen cases received ceftazidime as a therapeutic agent and five prophylactic ally. Thirteen of these patients showed clinical improvement with ceftazidime therapy and pathogens were eradicated in nine; the remaining six had aerobic Gram positive and anaerobic Gram negative bacteria presented;P. aeruginosa(1), E coli (1), Klebsiella oxytoca (1), Streptococcus faecalis (1) and Bacteroid fragilis (3). The prophylactive group showed no signs of infections following single dose pre-and post-operative boost injections of ceftazidime. Ceftazidime appears to be a useful agent in the treatment of patients undergoing hepato-biliary surgery, and especially those with Gram negative aerobic bacteria infections.