ABSTRACT
The pharmacokinetics of cefuroxime, cefotiam, cefamandole, and ampicillin/sulbactam were randomly measured in 40 patients undergoing major orthopedic surgery associated with high blood and volume turnover and intraoperative blood salvage. Serum and bone concentrations and the pharmacokinetics occurring in the context of these procedures were measured. No changes in elimination half-life relative to a normal population occurred with cefuroxime, cefotiam, and ampicillin. Serum and tissue concentrations were slightly lower with cefamandole and sulbactam, but reapplication of the initial dose was required with all antibiotics 4 hours after the first application.
Subject(s)
Ampicillin/pharmacokinetics , Antibiotic Prophylaxis/methods , Cefamandole/pharmacokinetics , Cefotiam/pharmacokinetics , Cefuroxime/pharmacokinetics , Cephalosporins/pharmacokinetics , Drug Therapy, Combination/pharmacokinetics , Orthopedic Procedures , Sulbactam/pharmacokinetics , Aged , Ampicillin/economics , Ampicillin/metabolism , Antibiotic Prophylaxis/economics , Antibiotic Prophylaxis/standards , Blood Transfusion, Autologous/adverse effects , Bone and Bones/chemistry , Cefamandole/economics , Cefamandole/metabolism , Cefotiam/economics , Cefotiam/metabolism , Cefuroxime/economics , Cefuroxime/metabolism , Cephalosporins/economics , Cephalosporins/metabolism , Drug Monitoring , Drug Therapy, Combination/economics , Drug Therapy, Combination/metabolism , Female , Fluid Therapy/methods , Humans , Male , Metabolic Clearance Rate , Middle Aged , Orthopedic Procedures/adverse effects , Risk Factors , Sulbactam/economics , Sulbactam/metabolism , Time Factors , Tissue DistributionABSTRACT
We analysed retrospectively 460 patients treated between March 1991 and February 1992, in respect to a correct perioperative antibiotic prophylaxis. In our opinion a correct prophylaxis is a single-shot application, with a second dose given only during long operations (over 3 hours) or when blood loss is great. 240 of the 460 patients analysed (52.2%) were given antibiotics prophylactically. In 76.6% of the cases (n = 184) the prophylaxis was performed correctly. In 23.4% (n = 56) antibiotic application was extended indiscriminately into the post-operative phase. This calculated to costs three times higher than those actually necessary, causing us to spend 22,000-Swiss francs unnecessarily, one twelfth of the total cost of antibiotic treatment in our hospital each year. For economic reasons as well as to keep growth of resistant strains in check, an antibiotic prophylaxis should be restricted to the perioperative period in most cases as a single shot only.
Subject(s)
Abdomen/surgery , Antibiotic Prophylaxis/economics , Health Services Misuse/economics , Thoracic Surgery/economics , Vascular Surgical Procedures/economics , Cefamandole/administration & dosage , Cefamandole/economics , Cephalosporins/administration & dosage , Cephalosporins/economics , Costs and Cost Analysis , Female , Humans , Male , Retrospective Studies , SwitzerlandABSTRACT
We compared the effects of single dose (750 milligrams) prophylactic cefamandole delivered directly into the operative wound with local anesthesia (n = 162) with a control group (no antibiotics) (n = 162) in a randomized trial. No adverse effects were observed. There were seven wound abscesses in the untreated group compared with none in the group receiving antibiotic prophylaxis (p = 0.007). Six of the seven abscesses occurred as late as one month after the patient was discharged from the hospital. The costs of antibiotics used were ten times less than the costs of treatment of wound complications in the control group.
