Fluconazole Penetration into the Pancreas

Overview

Journal Antimicrob Agents Chemother

Publisher American Society for Microbiology

Specialty Pharmacology

Date 2000 Aug 22

PMID 10952621

Citations 10

Authors

S Shrikhande

H Friess

C Issenegger

M E Martignoni

H Yong

B Gloor

R Yeates

J Kleeff

M W Buchler

Affiliations

Soon will be listed here.

Abstract

Because of antibiotic prophylaxis for necrotizing pancreatitis, the frequency of fungal superinfection in patients with pancreatic necrosis is increasing. In this study we analyzed the penetration of fluconazole into the human pancreas and in experimental acute pancreatitis. In human pancreatic tissues, the mean fluconazole concentration was 8.19 +/- 3.38 microg/g (96% of the corresponding concentration in serum). In experimental edematous and necrotizing pancreatitis, 88 and 91% of the serum fluconazole concentration was found in the pancreas. These data show that fluconazole penetration into the pancreas is sufficient to prevent and/or treat fungal contamination in patients with pancreatic necrosis.

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References

Rogers T, Galgiani J . Activity of fluconazole (UK 49,858) and ketoconazole against Candida albicans in vitro and in vivo. Antimicrob Agents Chemother. 1986; 30(3):418-22. PMC: 180572. DOI: 10.1128/AAC.30.3.418. View

Beger H, Bittner R, Block S, Buchler M . Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. 1986; 91(2):433-8. DOI: 10.1016/0016-5085(86)90579-2. View

Hughes C, Bennett R, Tuna I, Beggs W . Activities of fluconazole (UK 49,858) and ketoconazole against ketoconazole-susceptible and -resistant Candida albicans. Antimicrob Agents Chemother. 1988; 32(2):209-12. PMC: 172136. DOI: 10.1128/AAC.32.2.209. View

Buchler M, Malfertheiner P, Friess H, Bittner R, Vanek E, Schlegel P . The penetration of antibiotics into human pancreas. Infection. 1989; 17(1):20-5. DOI: 10.1007/BF01643494. View

Beger H . Surgical management of necrotizing pancreatitis. Surg Clin North Am. 1989; 69(3):529-49. DOI: 10.1016/s0039-6109(16)44834-6. View

Buchler M, Malfertheiner P, Friess H, Isenmann R, Vanek E, Grimm H . Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology. 1992; 103(6):1902-8. DOI: 10.1016/0016-5085(92)91450-i. View

Pederzoli P, Bassi C, Vesentini S, Campedelli A . A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet. 1993; 176(5):480-3. View

Faergemann J, Laufen H . Levels of fluconazole in serum, stratum corneum, epidermis-dermis (without stratum corneum) and eccrine sweat. Clin Exp Dermatol. 1993; 18(2):102-6. DOI: 10.1111/j.1365-2230.1993.tb00987.x. View

Fischman A, Alpert N, Livni E, Ray S, Sinclair I, CALLAHAN R . Pharmacokinetics of 18F-labeled fluconazole in healthy human subjects by positron emission tomography. Antimicrob Agents Chemother. 1993; 37(6):1270-7. PMC: 187952. DOI: 10.1128/AAC.37.6.1270. View

10.

Aloia T, Solomkin J, FINK A, Nussbaum M, Bjornson S, Bell R . Candida in pancreatic infection: a clinical experience. Am Surg. 1994; 60(10):793-6. View

11.

Luiten E, Hop W, Lange J, Bruining H . Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg. 1995; 222(1):57-65. PMC: 1234756. DOI: 10.1097/00000658-199507000-00010. View

12.

Sainio V, Kemppainen E, Puolakkainen P, Taavitsainen M, Kivisaari L, Valtonen V . Early antibiotic treatment in acute necrotising pancreatitis. Lancet. 1995; 346(8976):663-7. DOI: 10.1016/s0140-6736(95)92280-6. View

13.

Hofbauer B, Friess H, Weber A, Baczako K, Kisling P, Schilling M . Hyperlipaemia intensifies the course of acute oedematous and acute necrotising pancreatitis in the rat. Gut. 1996; 38(5):753-8. PMC: 1383160. DOI: 10.1136/gut.38.5.753. View

14.

Uhl W, Isenmann R, Buchler M . Infections complicating pancreatitis: diagnosing, treating, preventing. New Horiz. 1998; 6(2 Suppl):S72-9. View

15.

Grewe M, Tsiotos G, Sarr M . Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg. 1999; 188(4):408-14. DOI: 10.1016/s1072-7515(98)00334-2. View

16.

Buchler M, Gloor B, Muller C, Friess H, Seiler C, Uhl W . Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000; 232(5):619-26. PMC: 1421214. DOI: 10.1097/00000658-200011000-00001. View

17.

Jones C, Polk Jr H, Fulton R . Pancreatic abscess. Am J Surg. 1975; 129(1):44-7. DOI: 10.1016/0002-9610(75)90165-8. View

18.

Becker J, Pemberton J, DiMagno E, Ilstrup D, MCILRATH D, Dozois R . Prognostic factors in pancreatic abscess. Surgery. 1984; 96(3):455-61. View

19.

Malangoni M, Richardson J, Shallcross J, Seiler J, Polk Jr H . Factors contributing to fatal outcome after treatment of pancreatic abscess. Ann Surg. 1986; 203(6):605-13. PMC: 1251186. DOI: 10.1097/00000658-198606000-00004. View

20.

Gerzof S, Banks P, Robbins A, Johnson W, Spechler S, Wetzner S . Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology. 1987; 93(6):1315-20. DOI: 10.1016/0016-5085(87)90261-7. View