Effect of cephalosporins on bilirubin-albumin binding

The effect of parenterally administered cephalosporins on bilirubin-albumin binding was measured in vitro by means of the peroxidase method with human serum albumin and by means of a dialysis rate method with newborn infants' serum. Ceftriaxone and cefoperazone have been shown to affect bilirubin-albumin binding. In this study, 13 additional cephalosporins were tested. Cefonicid, cefotetan, and cefmetazole competed with bilirubin for albumin binding and, at reported mean peak serum levels, decreased the reserve albumin concentration by 75%, 56%, and 40%, respectively. We suggest that these five cephalosporins may increase the risk of bilirubin encephalopathy in jaundiced neonates.