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Cefuroxime plasma and tissue concentrations in patients undergoing elective cardiac surgery: Continuous vs bolus application. A pilot study
Author(s) -
SkhirtladzeDworschak Keso,
Hutschala Doris,
Reining Georg,
Dittrich Peter,
Bartunek Anna,
Dworschak Martin,
Tschernko Edda M.
Publication year - 2019
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13865
Subject(s) - cefuroxime , medicine , pharmacokinetics , bolus (digestion) , interquartile range , area under the curve , anesthesia , microdialysis , surgery , urology , antibiotics , chemistry , biochemistry , central nervous system
Aims Surgical site infections contribute to morbidity and mortality after surgery. The authors hypothesized that higher antibiotic tissue concentrations can be reached for a prolonged time span by continuous administration of prophylactic cefuroxime compared to bolus administration. Methods Twelve patients undergoing elective cardiac surgery were investigated. Group A received 1.5 g cefuroxime as bolus infusions before surgery, and 12 and 24 hours thereafter. In group B, a continuous infusion of 3.0 g cefuroxime was started after a bolus of 1.5 g. Cefuroxim levels were determined in blood and tissue (microdialysis). T ‐test, Wilcoxon signed rank test and χ 2 test were used for statistical analysis. Results The area under the curve (AUC) of plasma cefuroxime concentrations was greater in group B (399 [333–518]) as compared to group A (257 [177–297] h mg L −1 , [median and interquartile range], P = .026). Furthermore, a significantly longer percentage of time > minimal inhibitory concentrations of 2 mg L −1 (100% vs 50%), 4 mg L −1 (100% vs 42%), 8 mg L −1 (100% vs 17%) and 16 mg L −1 (83% vs 8%) was found for free plasma cefuroxime in group B. In group B, area under the curve in subcutaneous tissue (78 [61–113] h mg L −1 ) and median peak concentration (33 [26–38] mg L −1 ) were markedly higher compared to group A ( P = 0.041 and P = .026, respectively). Conclusions Higher cefuroxime concentrations were measured in plasma and subcutaneously over a prolonged period of time when cefuroxime was administered continuously. The clinical implication of this finding still has to be elucidated.