Excretion of cefuroxime in biliary disease

Cefuroxime is a broad spectrum B-lactamase stable cephalosporin antibiotic. An intravenous injection of cefuroxime sodium 1.5 grams was administered to 45 patients after induction of anesthesia for cholecystectomy. Twenty-five patients had elective operations for chronic cholecystitis and 20 underwent urgent operations for acute cholecystitis. Of the 25 patients who underwent elective treatment, the cystic duct was patent in 13 and obstructed in 12. Antibiotic concentrations were measured by microbiologic assay in plasma, common bile duct bile, gallbladder bile and gallbladder wall. Organisms grown from the bile (Escherischia coli, eight; Proteus morganii, one; Streptococcus species, three, and Staphylococcus aureus, one) were sensitive to cefuroxime with the exception of one instance of Streptococcus faecalis. Cefuroxime levels were the same in specimens of patients with chronic or acute cholecystitis and reached therapeutic levels in the gallbladder wall, the main site of the inflammatory reaction. There was no difference in bile levels from gallbladders with patent or obstructed cystic ducts, suggesting that cefuroxime diffuses into the gallbladder and bile from the blood stream. There were no wound infections in this study when only a single dosage of antibiotic was administered intravenously.