Penetration of clindamycin phosphate into the abnormal human biliary tract

Clindamycin phosphate, 600 mg, was given intravenously to 14 patients undergoing biliary tract surgery. Seven had complete obstruction of the common bile duct. Concentrations of total and active (nonesterified) antibiotic were measured in serum, gall bladder and common duct bile, gall bladder wall, and liver. Persons with patent common ducts had high levels of active drug at all hepatobiliary sites; concentrations were two and one half to three times higher in bile and liver than in serum. Persons with obstruction of the common duct had no measurable drug in bile and had reduced levels in gall bladder wall; however, concentrations in the liver were slightly higher than those in the group without obstruction. The results of this study suggest that, even in the presence of common duct obstruction, the concentrations of active clindamycin in the liver may be sufficient to limit the spread of intrahepatic infections due to susceptible organisms.