Serum oxacillin and cephazolin levels during cardiopulmonary bypass

Abstract

This study was carried out to assess the adequacy of the dosing regimen for the oxacillin and cephazolin, employed as prophylactic antibiotics for patients undergoing open-heart surgery. The serum levels of both antibiotics were measured during cardiopulmonary bypass.

The highest serum levels of both antibiotics were found 30 minutes after their administration (> 24mg/l). During perfusion the serum levels were not stable and decreased to < 2mg/l after 180 minutes in the oxacillin group and after 150 minutes in the cephazolin group. These levels are below the minimum inhibitory concentrations for anti-staphylococcal activity. A second dose of antibiotic at the end of cardiopulmonary bypass should be administered in order to maintain an anti-staphylococcal concentration of antibiotics in the newly formed blood clots. Earlier administration of both antibiotics is recommended in cases where perfusion time exceeds the above mentioned intervals.

Get full access to this article

View all access options for this article.

References

Aki BF , Richardson G. Serum cefazolin levels during CPB. Ann Thor Surg 1980; 29: 109-12.

Goldmann DA , Hopkins CC , Karchmer AW et al. Cephalothin prophylaxis in cardiac valve surgery. J Thorac Cardiovasc Surg 1977; 73: 470-79.

Mészáros R. , Windisch M. , Koltai C. , Lukács L. Comparative study of cefamandole versus cephalothin as antibiotic prophylaxis for open heart surgery. Cor Vasa 1986; 28: 61—66.

Wells FC , Newsom SW , Rowlands C. Wound infection in cardiothoracic surgery. Lancet 1983; 1: 1209-10.

Wilson Apr , Treasure T. , Sturidge MF et al. Antibiotic prophylaxis in cardiothoracic surgery in the United Kingdom: current practice. Thorax 1986; 41: 396-400.

Modr Z. Infekce v kardiochirurgii. Panelová diskuse. Dešvtné v Orlických horách, 1985.

Olson NH , Nightingale Ch H. , Quintilari R. Penetration characteristics of cefamandole into the right atrial appendage and pericardial fluid in patients undergoing open-heart surgery. Ann Thor Surg 1980; 29: 104—108.

Pien FD , Michael NL , Mamiya R. et al. Comparative study of prophylactic antibiotics in cardiac surgery, clindamycin versus cephalothin. J Thorac Cardiovasc Surg 1979; 77: 908.

Pieper R. , Henze A. , Josefssjon K. et al. Penetration of penicillins into cardiac valves and auricles of patients undergoing open-heart surgery. Scand J Thor Cardiovasc Surg 1985; 19: 49-53.