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Pharmacokinetics of Cefazolin Applied Topically to the Surgical Wound

Pharmacokinetics of Cefazolin Applied Topically to the Surgical Wound Abstract • Topical application of antibiotics is used in the prophylaxis of postoperative surgical infections. However, whether topically applied antibiotics remain primarily in the surgical wound fluid or are systemically absorbed is uncertain. The pharmacokinetics of topically applied cefazolin were studied in a canine model that allowed simultaneous determination of serum and wound fluid antibiotic concentrations. Topical administration of cefazolin resulted in high antibiotic concentrations in the wound fluid for prolonged periods and rapid systemic absorption. Bioavailability after topical administration was 95%. Within 1 hour, the serum concentrations after topical administration equaled the serum concentrations after intravenous administration, and the concentration time curves declined in parallel. In wound fluid, the mean time above the susceptibility break point minimum inhibitory concentration after topical administration of cefazolin was 5.76 hours compared with the estimated time above the minimum inhibitory concentration of 2.55 hours after intravenous administration. (Arch Surg. 1991;126:890-893) References 1. Kaiser AB. Antimicrobial prophylaxis in surgery . N Engl J Med . 1986;315:1129-1138.Crossref 2. Halasz NA. Wound infection and topical antibiotics . Arch Surg . 1977;112:1240-1244.Crossref 3. Lord JWJr, Laraja RD, Daliana M, Gordon MT. Prophylactic antibiotic irrigation in gastric, biliary and colonic surgery . Am J Surg . 1983;145:209-212.Crossref 4. Rosenstein BD, Wilson FC, Funderburk CH. The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds: an experimental study . J Bone Joint Surg Am . 1989;71:427-430. 5. Scher KS. Prevention of wound infection: the comparative effectiveness of topical and systemic cefazolin and povidoneiodine . Am Surg . 1982;48:268-270. 6. Levano KJ, Quirk JG, Cunningham FG, Nelson S, Bawdon RE. Perioperative antimicrobials at cesarean section: lavage versus three intravenous doses . Am J Obstet Gynecol . 1984;149:463-464.Crossref 7. Elliot JP, Flaherty JF, Comparison of lavage or intravenous antibiotic at cesarean section . Obstet Gynecol . 1986;67:29-32. 8. Sarr MG, Parikh KJ, Sanfey H, Minken SL, Cameron JL. Topical antibiotics in the high-risk patients: a prospective, randomized study . Am J Surg . 1988;155:337-342.Crossref 9. Glotzer DJ. Topical antibiotic prophylaxis in contaminated wounds: experimental evaluation . Arch Surg . 1970;100:589-593.Crossref 10. Long WH, Rudd EG, Dillon MB. Intrauterine irrigation with cefamandole nafate solution at cesarean section: a preliminary report . Am J Obstet Gynecol . 1980;138:755. 11. Flaherty JF, Boswell GW, Winkel CA, Elliot JP. Pharmacokinetics of cefoxitin in patients at term gestation: lavage versus intravenous administration . Am J Obstet Gynecol . 1983;146:760-766. 12. Duff P, Gibbs RS, Jorgensen JH, Alexander G. The pharmacokinetics of prophylactic antibiotics administered by intraoperative irrigation at the time of cesarean section . Obstet Gynecol . 1982;60:409-412. 13. Waterman NG, Howell RS, Babich M. The effect of a prophylactic topical antibiotic (cephalothin) on the incidence of wound infection . Arch Surg . 1968;97:365-370.Crossref 14. Benjamin JB, Volz RG. Efficacy of a topical irrigant in decreasing or eliminating bacterial contamination in surgical wounds . Clin Orthop . 1984;184:114-117. 15. Bennett JV, Brodie JL, Benner EJ, Kirby WMM. Simplified, accurate method for antibiotic assay of clinical specimens . Appl Microbiol . 1966;14:170-177. 16. Rosin E, Ebert S, Uphoff TS, Evans MH, Schultz-Darken NJ. Penetration of antibiotics into the surgical wound in a canine model . Antimicrob Agents Chemother . 1989;33:700-704.Crossref 17. Conover WB, Moore TR. Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section . Obstet Gynecol . 1984;63:787-791. 18. Polk HC, Lopez-Mayor JF, Postoperative wound infection: a prospective study of determinant factors and prevention . Surgery . 1969;66:97-103. 19. Vogelman B, Gudmundsson S, Leggett J, Turnidge J, Ebert S, Craig WA. Correlation of antimicrobial pharmacokinetic parameters with therapeutic efficacy in an animal model . J Infect Dis . 1988;158:831-847.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Pharmacokinetics of Cefazolin Applied Topically to the Surgical Wound

Archives of Surgery , Volume 126 (7) – Jul 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410310100015
Publisher site
See Article on Publisher Site

Abstract

Abstract • Topical application of antibiotics is used in the prophylaxis of postoperative surgical infections. However, whether topically applied antibiotics remain primarily in the surgical wound fluid or are systemically absorbed is uncertain. The pharmacokinetics of topically applied cefazolin were studied in a canine model that allowed simultaneous determination of serum and wound fluid antibiotic concentrations. Topical administration of cefazolin resulted in high antibiotic concentrations in the wound fluid for prolonged periods and rapid systemic absorption. Bioavailability after topical administration was 95%. Within 1 hour, the serum concentrations after topical administration equaled the serum concentrations after intravenous administration, and the concentration time curves declined in parallel. In wound fluid, the mean time above the susceptibility break point minimum inhibitory concentration after topical administration of cefazolin was 5.76 hours compared with the estimated time above the minimum inhibitory concentration of 2.55 hours after intravenous administration. (Arch Surg. 1991;126:890-893) References 1. Kaiser AB. Antimicrobial prophylaxis in surgery . N Engl J Med . 1986;315:1129-1138.Crossref 2. Halasz NA. Wound infection and topical antibiotics . Arch Surg . 1977;112:1240-1244.Crossref 3. Lord JWJr, Laraja RD, Daliana M, Gordon MT. Prophylactic antibiotic irrigation in gastric, biliary and colonic surgery . Am J Surg . 1983;145:209-212.Crossref 4. Rosenstein BD, Wilson FC, Funderburk CH. The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds: an experimental study . J Bone Joint Surg Am . 1989;71:427-430. 5. Scher KS. Prevention of wound infection: the comparative effectiveness of topical and systemic cefazolin and povidoneiodine . Am Surg . 1982;48:268-270. 6. Levano KJ, Quirk JG, Cunningham FG, Nelson S, Bawdon RE. Perioperative antimicrobials at cesarean section: lavage versus three intravenous doses . Am J Obstet Gynecol . 1984;149:463-464.Crossref 7. Elliot JP, Flaherty JF, Comparison of lavage or intravenous antibiotic at cesarean section . Obstet Gynecol . 1986;67:29-32. 8. Sarr MG, Parikh KJ, Sanfey H, Minken SL, Cameron JL. Topical antibiotics in the high-risk patients: a prospective, randomized study . Am J Surg . 1988;155:337-342.Crossref 9. Glotzer DJ. Topical antibiotic prophylaxis in contaminated wounds: experimental evaluation . Arch Surg . 1970;100:589-593.Crossref 10. Long WH, Rudd EG, Dillon MB. Intrauterine irrigation with cefamandole nafate solution at cesarean section: a preliminary report . Am J Obstet Gynecol . 1980;138:755. 11. Flaherty JF, Boswell GW, Winkel CA, Elliot JP. Pharmacokinetics of cefoxitin in patients at term gestation: lavage versus intravenous administration . Am J Obstet Gynecol . 1983;146:760-766. 12. Duff P, Gibbs RS, Jorgensen JH, Alexander G. The pharmacokinetics of prophylactic antibiotics administered by intraoperative irrigation at the time of cesarean section . Obstet Gynecol . 1982;60:409-412. 13. Waterman NG, Howell RS, Babich M. The effect of a prophylactic topical antibiotic (cephalothin) on the incidence of wound infection . Arch Surg . 1968;97:365-370.Crossref 14. Benjamin JB, Volz RG. Efficacy of a topical irrigant in decreasing or eliminating bacterial contamination in surgical wounds . Clin Orthop . 1984;184:114-117. 15. Bennett JV, Brodie JL, Benner EJ, Kirby WMM. Simplified, accurate method for antibiotic assay of clinical specimens . Appl Microbiol . 1966;14:170-177. 16. Rosin E, Ebert S, Uphoff TS, Evans MH, Schultz-Darken NJ. Penetration of antibiotics into the surgical wound in a canine model . Antimicrob Agents Chemother . 1989;33:700-704.Crossref 17. Conover WB, Moore TR. Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section . Obstet Gynecol . 1984;63:787-791. 18. Polk HC, Lopez-Mayor JF, Postoperative wound infection: a prospective study of determinant factors and prevention . Surgery . 1969;66:97-103. 19. Vogelman B, Gudmundsson S, Leggett J, Turnidge J, Ebert S, Craig WA. Correlation of antimicrobial pharmacokinetic parameters with therapeutic efficacy in an animal model . J Infect Dis . 1988;158:831-847.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1991

References