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June 1989

Prospective Randomized Comparison of Mezlocillin Therapy Alone With Combined Ampicillin and Gentamicin Therapy for Patients With Cholangitis

Author Affiliations

From the Mayo Clinic, Rochester, Minn (Drs Henry, LaRusso, Rosenblatt, and Wilson and Ms Muller), and Central Plains Clinic, Ltd, Sioux Falls, SD (Dr Hoffman). Dr Gerecht is in private practice in Springfield, Mo.

Arch Intern Med. 1989;149(6):1279-1284. doi:10.1001/archinte.1989.00390060033007

• Forty-six patients with cholangitis were randomized to receive therapy with mezlocillin sodium (24 patients) or a combination of ampicillin sodium—gentamicin sulfate (22 patients). The biliary concentration of mezlocillin was 112 times higher than that of ampicillin and 778 times higher than that of gentamicin. The ratio of the concentration in serum or bile over the minimum inhibitory concentration against aerobic gram-negative bacilli (therapeutic index) was higher for mezlocillin than for either ampicillin or gentamicin. Twenty (83%) of 24 patients were cured following mezlocillin therapy compared with 9 (41%) of 22 patients after ampicillin-gentamicin therapy. The 3 patients with superinfection were in the ampicillin-gentamicin arm of the study. Fewer toxic or adverse effects occurred in association with mezlocillin treatment than with ampicillin-gentamicin treatment. Mezlocillin therapy was more effective, less toxic, and less expensive than treatment with ampicillin and gentamicin for patients with cholangitis.

(Arch Intern Med. 1989;149:1279-1284)

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